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LaCoursiere CM, Ullmann JF, Koh HY, Turner L, Baker CM, Robens B, Shao W, Rotenberg A, McGraw CM, Poduri AH. Zebrafish models of candidate human epilepsy-associated genes provide evidence of hyperexcitability. iScience 2024; 27:110172. [PMID: 39021799 PMCID: PMC11253282 DOI: 10.1016/j.isci.2024.110172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 05/13/2024] [Accepted: 05/31/2024] [Indexed: 07/20/2024] Open
Abstract
Hundreds of novel candidate human epilepsy-associated genes have been identified thanks to advancements in next-generation sequencing and large genome-wide association studies, but establishing genetic etiology requires functional validation. We generated a list of >2,200 candidate epilepsy-associated genes, of which 48 were developed into stable loss-of-function (LOF) zebrafish models. Of those 48, evidence of seizure-like behavior was present in 5 (arfgef1, kcnd2, kcnv1, ubr5, and wnt8b). Further characterization provided evidence for epileptiform activity via electrophysiology in kcnd2 and wnt8b mutants. Additionally, arfgef1 and wnt8b mutants showed a decrease in the number of inhibitory interneurons in the optic tectum of larval animals. Further, RNA sequencing (RNA-seq) revealed convergent transcriptional abnormalities between mutant lines, consistent with their developmental defects and hyperexcitable phenotypes. These zebrafish models provide strongest experimental evidence supporting the role of ARFGEF1, KCND2, and WNT8B in human epilepsy and further demonstrate the utility of this model system for evaluating candidate human epilepsy genes.
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Affiliation(s)
- Christopher Mark LaCoursiere
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Jeremy F.P. Ullmann
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Hyun Yong Koh
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Departments of Neuroscience and Pediatrics, Division of Neurology and Developmental Neuroscience, BCM, Houston, TX 77030, USA
| | - Laura Turner
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Cristina M. Baker
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Kavli Institute for Systems Neuroscience, Norwegian University of Science and Technology, 7034 Trondheim, Norway
| | - Barbara Robens
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Wanqing Shao
- Research Computing, Department of Information Technology, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Alexander Rotenberg
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Christopher M. McGraw
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Annapurna H. Poduri
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children’s Hospital, Boston, MA 02115, USA
- Department of Neurology, Harvard Medical School, Boston, MA 02115, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA 02114, USA
- Broad Institute of Harvard and MIT, Cambridge, MA 02142, USA
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LaCoursiere CM, Ullmann JFP, Koh HY, Turner L, Baker CM, Robens B, Shao W, Rotenberg A, McGraw CM, Poduri A. Zebrafish models of candidate human epilepsy-associated genes provide evidence of hyperexcitability. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.02.07.579190. [PMID: 38370728 PMCID: PMC10871320 DOI: 10.1101/2024.02.07.579190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
Hundreds of novel candidate human epilepsy-associated genes have been identified thanks to advancements in next-generation sequencing and large genome-wide association studies, but establishing genetic etiology requires functional validation. We generated a list of >2200 candidate epilepsy-associated genes, of which 81 were determined suitable for the generation of loss-of-function zebrafish models via CRISPR/Cas9 gene editing. Of those 81 crispants, 48 were successfully established as stable mutant lines and assessed for seizure-like swim patterns in a primary F2 screen. Evidence of seizure-like behavior was present in 5 (arfgef1, kcnd2, kcnv1, ubr5, wnt8b) of the 48 mutant lines assessed. Further characterization of those 5 lines provided evidence for epileptiform activity via electrophysiology in kcnd2 and wnt8b mutants. Additionally, arfgef1 and wnt8b mutants showed a decrease in the number of inhibitory interneurons in the optic tectum of larval animals. Furthermore, RNAseq revealed convergent transcriptional abnormalities between mutant lines, consistent with their developmental defects and hyperexcitable phenotypes. These zebrafish models provide strongest experimental evidence supporting the role of ARFGEF1, KCND2, and WNT8B in human epilepsy and further demonstrate the utility of this model system for evaluating candidate human epilepsy genes.
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Affiliation(s)
- Christopher Mark LaCoursiere
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Jeremy F P Ullmann
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Hyun Yong Koh
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Departments of Neuroscience and Pediatrics, Division of Neurology and Developmental Neuroscience, BCM, Houston, Texas, USA
| | - Laura Turner
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Cristina M Baker
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Kavli Institute for Systems Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway
| | - Barbara Robens
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Wanqing Shao
- Research Computing, Department of Information Technology, Boston Children's Hospital, Boston, MA, USA
| | - Alexander Rotenberg
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Christopher M McGraw
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Massachusetts General Hospital, Boston, MA, USA
| | - Annapurna Poduri
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Epilepsy Genetics Program, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, MA, USA
- Broad Institute of Harvard and MIT, Cambridge, MA, USA
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De Wachter M, Schoonjans AS, Weckhuysen S, Van Schil K, Löfgren A, Meuwissen M, Jansen A, Ceulemans B. From diagnosis to treatment in genetic epilepsies: Implementation of precision medicine in real-world clinical practice. Eur J Paediatr Neurol 2024; 48:46-60. [PMID: 38039826 DOI: 10.1016/j.ejpn.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 07/20/2023] [Accepted: 11/11/2023] [Indexed: 12/03/2023]
Abstract
The implementation of whole exome sequencing (WES) has had a major impact on the diagnostic yield of genetic testing in individuals with epilepsy. The identification of a genetic etiology paves the way to precision medicine: an individualized treatment approach, based on the disease pathophysiology. The aim of this retrospective cohort study was to: (1) determine the diagnostic yield of WES in a heterogeneous cohort of individuals with epilepsy referred for genetic testing in a real-world clinical setting, (2) investigate the influence of epilepsy characteristics on the diagnostic yield, (3) determine the theoretical yield of treatment changes based on genetic diagnosis and (4) explore the barriers to implementation of precision medicine. WES was performed in 247 individuals with epilepsy, aged between 7 months and 68 years. In 34/247 (14 %) a (likely) pathogenic variant was identified. In 7/34 (21 %) of these individuals the variant was found using a HPO-based filtering. Diagnostic yield was highest for individuals with an early onset of epilepsy (39 %) or in those with a developmental and epileptic encephalopathy (34 %). Precision medicine was a theoretical possibility in 20/34 (59 %) of the individuals with a (likely) pathogenic variant but implemented in only 11/34 (32 %). The major barrier to implementation of precision treatment was the limited availability or reimbursement of a given drug. These results confirm the potential impact of genetic analysis on treatment choices, but also highlight the hurdles to the implementation of precision medicine. To optimize precision medicine in real-world practice, additional endeavors are needed: unifying definitions of precision medicine, establishment of publicly accessible databases that include data on the functional effect of gene variants, increasing availability and reimbursement of precision therapeutics, and broadening access to innovative clinical trials.
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Affiliation(s)
- Matthias De Wachter
- Department of Pediatric Neurology, Antwerp University Hospital, University of Antwerp, Drie eikenstraat 655, 2650, Edegem, Belgium.
| | - An-Sofie Schoonjans
- Department of Pediatric Neurology, Antwerp University Hospital, University of Antwerp, Drie eikenstraat 655, 2650, Edegem, Belgium
| | - Sarah Weckhuysen
- Department of Neurology, Antwerp University Hospital, University of Antwerp, Drie eikenstraat 655, 2650, Edegem, Belgium; Applied&Translational Neurogenomics Group, VIB-CMN, VIB, UAntwerpen, Universiteitsplein 1, 2610, Wilrijk, Belgium; Translational Neurosciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Kristof Van Schil
- Department of Medical Genetics, Antwerp University Hospital, University of Antwerp, Drie eikenstraat 655, 2650, Edegem, Belgium
| | - Ann Löfgren
- Department of Medical Genetics, Antwerp University Hospital, University of Antwerp, Drie eikenstraat 655, 2650, Edegem, Belgium
| | - Marije Meuwissen
- Department of Medical Genetics, Antwerp University Hospital, University of Antwerp, Drie eikenstraat 655, 2650, Edegem, Belgium
| | - Anna Jansen
- Department of Pediatric Neurology, Antwerp University Hospital, University of Antwerp, Drie eikenstraat 655, 2650, Edegem, Belgium; Translational Neurosciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
| | - Berten Ceulemans
- Department of Pediatric Neurology, Antwerp University Hospital, University of Antwerp, Drie eikenstraat 655, 2650, Edegem, Belgium
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Koh HY, Smith L, Wiltrout KN, Podury A, Chourasia N, D’Gama AM, Park M, Knight D, Sexton EL, Koh JJ, Oby B, Pinsky R, Shao DD, French CE, Shao W, Rockowitz S, Sliz P, Zhang B, Mahida S, Moufawad El Achkar C, Yuskaitis CJ, Olson HE, Sheidley BR, Poduri AH. Utility of Exome Sequencing for Diagnosis in Unexplained Pediatric-Onset Epilepsy. JAMA Netw Open 2023; 6:e2324380. [PMID: 37471090 PMCID: PMC10359957 DOI: 10.1001/jamanetworkopen.2023.24380] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/31/2023] [Indexed: 07/21/2023] Open
Abstract
Importance Genomic advances inform our understanding of epilepsy and can be translated to patients as precision diagnoses that influence clinical treatment, prognosis, and counseling. Objective To delineate the genetic landscape of pediatric epilepsy and clinical utility of genetic diagnoses for patients with epilepsy. Design, Setting, and Participants This cohort study used phenotypic data from medical records and treating clinicians at a pediatric hospital to identify patients with unexplained pediatric-onset epilepsy. Exome sequencing was performed for 522 patients and available biological parents, and sequencing data were analyzed for single nucleotide variants (SNVs) and copy number variants (CNVs). Variant pathogenicity was assessed, patients were provided with their diagnostic results, and clinical utility was evaluated. Patients were enrolled from August 2018 to October 2021, and data were analyzed through December 2022. Exposures Phenotypic features associated with diagnostic genetic results. Main Outcomes and Measures Main outcomes included diagnostic yield and clinical utility. Diagnostic findings included variants curated as pathogenic, likely pathogenic (PLP), or diagnostic variants of uncertain significance (VUS) with clinical features consistent with the involved gene's associated phenotype. The proportion of the cohort with diagnostic findings, the genes involved, and their clinical utility, defined as impact on clinical treatment, prognosis, or surveillance, are reported. Results A total of 522 children (269 [51.5%] male; mean [SD] age at seizure onset, 1.2 [1.4] years) were enrolled, including 142 children (27%) with developmental epileptic encephalopathy and 263 children (50.4%) with intellectual disability. Of these, 100 participants (19.2%) had identifiable genetic explanations for their seizures: 89 participants had SNVs (87 germline, 2 somatic mosaic) involving 69 genes, and 11 participants had CNVs. The likelihood of identifying a genetic diagnosis was highest in patients with intellectual disability (adjusted odds ratio [aOR], 2.44; 95% CI, 1.40-4.26), early onset seizures (aOR, 0.93; 95% CI, 0.88-0.98), and motor impairment (aOR, 2.19; 95% CI 1.34-3.58). Among 43 patients with apparently de novo variants, 2 were subsequently determined to have asymptomatic parents harboring mosaic variants. Of 71 patients who received diagnostic results and were followed clinically, 29 (41%) had documented clinical utility resulting from their genetic diagnoses. Conclusions and Relevance These findings suggest that pediatric-onset epilepsy is genetically heterogeneous and that some patients with previously unexplained pediatric-onset epilepsy had genetic diagnoses with direct clinical implications.
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Affiliation(s)
- Hyun Yong Koh
- Epilepsy Genetics Program, Boston Children’s Hospital, Boston, Massachusetts
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- F.M. Kirby Neurobiology Center, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
- The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts
| | - Lacey Smith
- Epilepsy Genetics Program, Boston Children’s Hospital, Boston, Massachusetts
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Kimberly N. Wiltrout
- Epilepsy Genetics Program, Boston Children’s Hospital, Boston, Massachusetts
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | | | - Nitish Chourasia
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics and Neurology, University of Tennessee Health Science Center, Memphis
| | - Alissa M. D’Gama
- Epilepsy Genetics Program, Boston Children’s Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- Division of Newborn Medicine, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Meredith Park
- Epilepsy Genetics Program, Boston Children’s Hospital, Boston, Massachusetts
| | - Devon Knight
- Epilepsy Genetics Program, Boston Children’s Hospital, Boston, Massachusetts
| | - Emma L. Sexton
- Epilepsy Genetics Program, Boston Children’s Hospital, Boston, Massachusetts
| | - Julia J. Koh
- Epilepsy Genetics Program, Boston Children’s Hospital, Boston, Massachusetts
| | - Brandon Oby
- Epilepsy Genetics Program, Boston Children’s Hospital, Boston, Massachusetts
| | - Rebecca Pinsky
- Epilepsy Genetics Program, Boston Children’s Hospital, Boston, Massachusetts
| | - Diane D. Shao
- Epilepsy Genetics Program, Boston Children’s Hospital, Boston, Massachusetts
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Courtney E. French
- Research Computing, Department of Information Technology, Boston Children’s Hospital, Boston, Massachusetts
| | - Wanqing Shao
- Research Computing, Department of Information Technology, Boston Children’s Hospital, Boston, Massachusetts
| | - Shira Rockowitz
- The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts
- Research Computing, Department of Information Technology, Boston Children’s Hospital, Boston, Massachusetts
| | - Piotr Sliz
- The Manton Center for Orphan Disease Research, Boston Children’s Hospital, Boston, Massachusetts
- Research Computing, Department of Information Technology, Boston Children’s Hospital, Boston, Massachusetts
- Division of Molecular Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Bo Zhang
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, Massachusetts
| | - Sonal Mahida
- Epilepsy Genetics Program, Boston Children’s Hospital, Boston, Massachusetts
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Christelle Moufawad El Achkar
- Epilepsy Genetics Program, Boston Children’s Hospital, Boston, Massachusetts
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
- Biostatistics and Research Design Center, Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, Massachusetts
| | - Christopher J. Yuskaitis
- Epilepsy Genetics Program, Boston Children’s Hospital, Boston, Massachusetts
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- F.M. Kirby Neurobiology Center, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Heather E. Olson
- Epilepsy Genetics Program, Boston Children’s Hospital, Boston, Massachusetts
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- F.M. Kirby Neurobiology Center, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
| | - Beth Rosen Sheidley
- Epilepsy Genetics Program, Boston Children’s Hospital, Boston, Massachusetts
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
| | - Annapurna H. Poduri
- Epilepsy Genetics Program, Boston Children’s Hospital, Boston, Massachusetts
- Department of Neurology, Boston Children’s Hospital, Boston, Massachusetts
- F.M. Kirby Neurobiology Center, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Neurology, Harvard Medical School, Boston, Massachusetts
- Broad Institute of MIT and Harvard, Cambridge, Massachusetts
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Kocaaga A, Yimenicioglu S. Identification of Novel Gene Variants in Children With Drug-Resistant Epilepsy: Expanding the Genetic Spectrum. Pediatr Neurol 2023; 139:7-12. [PMID: 36493596 DOI: 10.1016/j.pediatrneurol.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/09/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Resistance to antiseizure drugs is an important problem in the treatment of individuals with epilepsy. Identifying the molecular etiology of drug-resistant epilepsy (DRE) is crucial for better management of epilepsy. Here, we explore the utility of whole exome sequencing (WES) in identifying causative gene variants in children with DRE. METHODS Forty-five children with DRE who underwent WES tests were included. Genetic examination of all patients included chromosomal analysis and clinical chromosomal microarray followed by WES. The identified variants by WES analysis were classified for pathogenicity based on the American College of Medical Genetics and Genomics guidelines and in silico protein prediction tools. RESULTS The overall diagnostic yield was 55.5% (25 of 45). A total of 26 variants spanning 22 genes were identified in 25 patients. Of note, only 19 of these genes were examined as novel. Ten patients (22.2%) had a pathogenic or likely pathogenic variant. There was a trend associated with a diagnostic genetic test result in girls compared with boys in DRE (P = 0.028). CONCLUSION Our findings expand the mutational spectrum of genes related to DRE. To form disease-specific treatment in children with DRE, the WES analysis should be included in the diagnostic algorithm because of its high diagnostic efficiency.
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Affiliation(s)
- Ayca Kocaaga
- Department of Medical Genetics, Eskisehir City Hospital, Eskişehir, Turkey.
| | - Sevgi Yimenicioglu
- Department of Pediatric Neurology, Eskisehir City Hospital, Eskişehir, Turkey
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Smith L, Malinowski J, Ceulemans S, Peck K, Walton N, Sheidley BR, Lippa N. Genetic testing and counseling for the unexplained epilepsies: An evidence‐based practice guideline of the National Society of Genetic Counselors. J Genet Couns 2022; 32:266-280. [PMID: 36281494 DOI: 10.1002/jgc4.1646] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 09/27/2022] [Accepted: 10/01/2022] [Indexed: 11/10/2022]
Abstract
Epilepsy, defined by the occurrence of two or more unprovoked seizures or one unprovoked seizure with a propensity for others, affects 0.64% of the population and can lead to significant morbidity and mortality. A majority of unexplained epilepsy (seizures not attributed to an acquired etiology, such as trauma or infection) is estimated to have an underlying genetic etiology. Despite rapid progress in understanding of the genetic underpinnings of the epilepsies, there are no recent evidence-based guidelines for genetic testing and counseling for this population. This practice guideline provides evidence-based recommendations for approaching genetic testing in the epilepsies using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) Evidence to Decision framework. We used evidence from a recent systematic evidence review and meta-analysis of diagnostic yield of genetic tests in patients with epilepsy. We also compiled data from other sources, including recently submitted conference abstracts and peer-reviewed journal articles. We identified and prioritized outcomes of genetic testing as critical, important or not important and based our recommendations on outcomes deemed critical and important. We considered the desirable and undesirable effects, value and acceptability to relevant stakeholders, impact on health equity, cost-effectiveness, certainty of evidence, and feasibility of the interventions in individuals with epilepsy. Taken together, we generated two clinical recommendations: (1) Genetic testing is strongly recommended for all individuals with unexplained epilepsy, without limitation of age, with exome/genome sequencing and/or a multi-gene panel (>25 genes) as first-tier testing followed by chromosomal microarray, with exome/genome sequencing conditionally recommended over multi-gene panel. (2) It is strongly recommended that genetic tests be selected, ordered, and interpreted by a qualified healthcare provider in the setting of appropriate pre-test and post-test genetic counseling. Incorporation of genetic counselors into neurology practices and/or referral to genetics specialists are both useful models for supporting providers without genetics expertise to implement these recommendations.
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Affiliation(s)
- Lacey Smith
- Epilepsy Genetics Program, Department of Neurology Boston Children's Hospital Boston Massachusetts USA
| | | | - Sophia Ceulemans
- Department of Genetics, Department of Neurology Rady Children's Hospital San Diego California USA
| | - Katlin Peck
- Department of Laboratory Management eviCore Healthcare Bluffton South Carolina USA
| | - Nephi Walton
- Intermountain Precision Genomics Intermountain Healthcare St. George Utah USA
| | - Beth Rosen Sheidley
- Epilepsy Genetics Program, Department of Neurology Boston Children's Hospital Boston Massachusetts USA
| | - Natalie Lippa
- Instititute for Genomic Medicine Columbia University Irving Medical Center New York New York USA
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McTague A, Brunklaus A, Barcia G, Varadkar S, Zuberi SM, Chatron N, Parrini E, Mei D, Nabbout R, Lesca G. Defining causal variants in rare epilepsies: an essential team effort between biomedical scientists, geneticists and epileptologists. Eur J Med Genet 2022; 65:104531. [PMID: 35618197 DOI: 10.1016/j.ejmg.2022.104531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 05/01/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022]
Abstract
In the last few years, with the advent of next generation sequencing (NGS), our knowledge of genes associated with monogenic epilepsies has significantly improved. NGS is also a powerful diagnostic tool for patients with epilepsy, through gene panels, exomes and genomes. This has improved diagnostic yield, reducing the time between the first seizure and a definitive molecular diagnosis. However, these developments have also increased the complexity of data interpretation, due to the large number of variants identified in a given patient and due to the phenotypic variability associated with many of the epilepsy-related genes. In this paper, we present examples of variant classification in "real life" clinic situations. We emphasize the importance of accurate phenotyping of the epilepsies including recognising variable/milder phenotypes and expansion of previously described phenotypes. There are some important issues specific to rare epilepsies - mosaicism and reduced penetrance - which affect genetic counselling. These challenges may be overcome through multidisciplinary meetings including epileptologists, pediatric neurologists, and clinical and molecular geneticists, in which every specialist learns from the others in a process which leads to for rapid and accurate diagnosis. This is an important milestone to achieve as targeted therapiesbased on the functional effects of pathogenic variants become available.
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Affiliation(s)
- Amy McTague
- Developmental Neurosciences, UCL Great Ormond Street Institute of Child Health, Member of the ERN EpiCARE, London, UK; Department of Neurology, Great Ormond Street Institute of Child Health, Member of the ERN EpiCARE, London, UK.
| | - Andreas Brunklaus
- The Pediatric Neurosciences Research Group, Royal Hospital for Children, Member of the ERN EpiCARE, Glasgow, UK; Institute of Health and Wellbeing, University of Glasgow, Member of the ERN EpiCARE, Glasgow, UK
| | - Giulia Barcia
- Department of Pediatric Neurology, Centre de Reference Epilepsies Rares, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Member of the ERN EpiCARE, Paris, France
| | - Sophia Varadkar
- Department of Neurology, Great Ormond Street Institute of Child Health, Member of the ERN EpiCARE, London, UK
| | - Sameer M Zuberi
- The Pediatric Neurosciences Research Group, Royal Hospital for Children, Member of the ERN EpiCARE, Glasgow, UK; Institute of Health and Wellbeing, University of Glasgow, Member of the ERN EpiCARE, Glasgow, UK
| | - Nicolas Chatron
- Department of Medical Genetics, Lyon University Hospital, Université Claude Bernard Lyon 1, Member of the ERN EpiCARE, Lyon, France
| | - Elena Parrini
- Pediatric Neurology, Neurogenetics, and Neurobiology Unit and Laboratories, Meyer Children's Hospital - University of Florence, Member of the ERN EpiCARE, Florence, Italy
| | - Davide Mei
- Pediatric Neurology, Neurogenetics, and Neurobiology Unit and Laboratories, Meyer Children's Hospital - University of Florence, Member of the ERN EpiCARE, Florence, Italy
| | - Rima Nabbout
- Department of Pediatric Neurology, Centre de Reference Epilepsies Rares, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Member of the ERN EpiCARE, Paris, France
| | - Gaetan Lesca
- Department of Medical Genetics, Lyon University Hospital, Université Claude Bernard Lyon 1, Member of the ERN EpiCARE, Lyon, France
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Sheidley BR, Malinowski J, Bergner AL, Bier L, Gloss DS, Mu W, Mulhern MM, Partack EJ, Poduri A. Genetic testing for the epilepsies: A systematic review. Epilepsia 2021; 63:375-387. [PMID: 34893972 DOI: 10.1111/epi.17141] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Numerous genetic testing options for individuals with epilepsy have emerged over the past decade without clear guidelines regarding optimal testing strategies. We performed a systematic evidence review (SER) and conducted meta-analyses of the diagnostic yield of genetic tests commonly utilized for patients with epilepsy. We also assessed nonyield outcomes (NYOs) such as changes in treatment and/or management, prognostic information, recurrence risk determination, and genetic counseling. METHODS We performed an SER, in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), using PubMed, Embase, CINAHL, and Cochrane Central through December of 2020. We included studies that utilized genome sequencing (GS), exome sequencing (ES), multigene panel (MGP), and/or genome-wide comparative genomic hybridization/chromosomal microarray (CGH/CMA) in cohorts (n ≥ 10) ascertained for epilepsy. Quality assessment was undertaken using ROBINS-I (Risk of Bias in Non-Randomized Studies of Interventions). We estimated diagnostic yields and 95% confidence intervals with random effects meta-analyses and narratively synthesized NYOs. RESULTS From 5985 nonduplicated articles published through 2020, 154 met inclusion criteria and were included in meta-analyses of diagnostic yield; 43 of those were included in the NYO synthesis. The overall diagnostic yield across all test modalities was 17%, with the highest yield for GS (48%), followed by ES (24%), MGP (19%), and CGH/CMA (9%). The only phenotypic factors that were significantly associated with increased yield were (1) the presence of developmental and epileptic encephalopathy and/or (2) the presence of neurodevelopmental comorbidities. Studies reporting NYOs addressed clinical and personal utility of testing. SIGNIFICANCE This comprehensive SER, focused specifically on the literature regarding patients with epilepsy, provides a comparative assessment of the yield of clinically available tests, which will help shape clinician decision-making and policy regarding insurance coverage for genetic testing. We highlight the need for prospective assessment of the clinical and personal utility of genetic testing for patients with epilepsy and for standardization in reporting patient characteristics.
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Affiliation(s)
- Beth R Sheidley
- Epilepsy Genetics Program, Division of Epilepsy and Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA
| | | | - Amanda L Bergner
- Department of Genetics and Development, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Louise Bier
- Institute for Genomic Medicine, Columbia University Irving Medical Center, New York, New York, USA
| | - David S Gloss
- Department of Neurology, Charleston Area Medical Center, Charleston, West Virginia, USA
| | - Weiyi Mu
- Department of Genetic Medicine, Johns Hopkins University, Baltimore, Maryland, USA
| | - Maureen M Mulhern
- Department of Pathology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA.,Department of Neurology, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York, USA
| | - Emily J Partack
- Genomics Services, Quest Diagnostics, Marlborough, Massachusetts, USA
| | - Annapurna Poduri
- Epilepsy Genetics Program, Division of Epilepsy and Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, USA.,Department of Neurology, Harvard Medical School, Boston, Massachusetts, USA
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9
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Bosque JR, Gómez-Nieto R, Hormigo S, Herrero-Turrión MJ, Díaz-Casado E, Sancho C, López DE. Molecular tools for the characterization of seizure susceptibility in genetic rodent models of epilepsy. Epilepsy Behav 2021; 121:106594. [PMID: 31685382 DOI: 10.1016/j.yebeh.2019.106594] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 09/20/2019] [Accepted: 09/25/2019] [Indexed: 12/12/2022]
Abstract
Epilepsy is a chronic neurological disorder characterized by abnormal neuronal activity that arises from imbalances between excitatory and inhibitory synapses, which are highly correlated to functional and structural changes in specific brain regions. The difference between the normal and the epileptic brain may harbor genetic alterations, gene expression changes, and/or protein alterations in the epileptogenic nucleus. It is becoming increasingly clear that such differences contribute to the development of distinct epilepsy phenotypes. The current major challenges in epilepsy research include understanding the disease progression and clarifying epilepsy classifications by searching for novel molecular biomarkers. Thus, the application of molecular techniques to carry out comprehensive studies at deoxyribonucleic acid, messenger ribonucleic acid, and protein levels is of utmost importance to elucidate molecular dysregulations in the epileptic brain. The present review focused on the great diversity of technical approaches available and new research methodology, which are already being used to study molecular alterations underlying epilepsy. We have grouped the different techniques according to each step in the flow of information from DNA to RNA to proteins, and illustrated with specific examples in animal models of epilepsy, some of which are our own. Separately and collectively, the genomic and proteomic techniques, each with its own strengths and limitations, provide valuable information on molecular mechanisms underlying seizure susceptibility and regulation of neuronal excitability. Determining the molecular differences between genetic rodent models of epilepsy and their wild-type counterparts might be a key in determining mechanisms of seizure susceptibility and epileptogenesis as well as the discovery and development of novel antiepileptic agents. This article is part of the Special Issue "NEWroscience 2018".
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Affiliation(s)
- José Ramón Bosque
- Institute for Neuroscience of Castilla y León (INCyL), University of Salamanca, Salamanca, Spain; Salamanca Institute for Biomedical Research (IBSAL), Spain
| | - Ricardo Gómez-Nieto
- Institute for Neuroscience of Castilla y León (INCyL), University of Salamanca, Salamanca, Spain; Salamanca Institute for Biomedical Research (IBSAL), Spain; Department of Neurobiology and Anatomy, Drexel University College of Medicine, United States of America
| | - Sebastián Hormigo
- Institute for Neuroscience of Castilla y León (INCyL), University of Salamanca, Salamanca, Spain; Department of Cell Biology and Pathology, School of Medicine, University of Salamanca, Salamanca, Spain
| | - M Javier Herrero-Turrión
- Institute for Neuroscience of Castilla y León (INCyL), University of Salamanca, Salamanca, Spain; INCYL Neurological Tissue Bank (BTN-INCYL), Spain
| | - Elena Díaz-Casado
- Institute for Neuroscience of Castilla y León (INCyL), University of Salamanca, Salamanca, Spain; Salamanca Institute for Biomedical Research (IBSAL), Spain
| | - Consuelo Sancho
- Institute for Neuroscience of Castilla y León (INCyL), University of Salamanca, Salamanca, Spain; Salamanca Institute for Biomedical Research (IBSAL), Spain
| | - Dolores E López
- Institute for Neuroscience of Castilla y León (INCyL), University of Salamanca, Salamanca, Spain; Salamanca Institute for Biomedical Research (IBSAL), Spain; Department of Neurobiology and Anatomy, Drexel University College of Medicine, United States of America.
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10
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Wei Z, Liu C, Wu Z, Cao M, Qiao X, Han T, Zhang Y, Liu Y, Deng Y. The prognosis of epilepsy patients with CACNA1H missense variants: A longitudinal cohort study. Seizure 2021; 91:52-59. [PMID: 34098317 DOI: 10.1016/j.seizure.2021.05.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/19/2021] [Accepted: 05/21/2021] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE CACNA1H is regarded as a gene conferring susceptibility to generalised epilepsy. However, the prognosis of epilepsy patients carrying the CACNA1H missense variants of uncertain significance (VUS) is unknown. A prospective cohort was generated to determine the deleterious effects of these variants and to check whether the presence of these variants affects the prognosis of epilepsy patients. METHOD This study was conducted at Xijing Hospital in Xian, China. All patients were followed up for at least 1 year. Previous reports were searched for previously reported variants. Ensembl database was searched for variants in the general population. Combined Annotation Dependent Depletion (CADD) was used to evaluate the deleterious effect of variants. Logistic regression and Cox regression were used for data analysis. RESULTS The study included 176 epilepsy patients with or without CACNA1H variants. In epilepsy patients with missense variants, we found 35 different variants, including 33 variants with uncertain significance and 2 likely benign variants. No significant difference was observed between the distribution of CADD scores of the variants from this cohort, of the general population, and of those found in previous reports. Among epilepsy patients with missense variants, the number of antiepileptic drugs (AEDs) administered to the patients, a first-degree family history of epilepsy, and possibly the presence of abnormalities in brain radiology findings were correlated with the poorer prognosis. Among the entire cohort, the type of epilepsy, number of AEDs administered, and presence of abnormalities in brain radiology findings were associated with the prognosis of these patients. The deleterious effect of CACNA1H missense variants or their presence was not related to the prognosis of epilepsy patients. CONCLUSION The results of our study suggest that CACNA1H variants are related to multiple epilepsy syndromes. However, there is no strong evidence of the correlation between CACNA1H missense variants and a certain type of epilepsy. In our study cohort, both the deleterious effects and the presence of CACNA1H variants were found to be unrelated to the prognosis of patients with epilepsy. These findings suggest that CACNA1H missense variants that are classified as VUS might not influence the outcome of epilepsy.
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Affiliation(s)
- Zihan Wei
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, People's Republic of China
| | - Chao Liu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, People's Republic of China
| | - Zhenyu Wu
- Department of Anatomy, Histology and Embryology and K.K. Leung Brain Research Centre, School of Basic Medicine, Fourth Military Medical University, Xi'an 710032, China
| | - Mi Cao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, People's Republic of China
| | - Xiaozhi Qiao
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, People's Republic of China
| | - Tenghui Han
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, People's Republic of China
| | - Ying Zhang
- Department of Neurology, Xian International Medical Center, People's Republic of China
| | - Yonghong Liu
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, People's Republic of China
| | - Yanchun Deng
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an 710032, People's Republic of China.
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11
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Zheng Z, Zhong H, Zhang Q, Huang Q, Wu H. HLA-B*1502 is associated with aromatic anticonvulsant drug-induced cutaneous adverse drug reactions among the Hakka population in China. J Int Med Res 2021; 48:300060520911276. [PMID: 32228349 PMCID: PMC7132569 DOI: 10.1177/0300060520911276] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background The purpose of this study was to analyze the correlation between aromatic
antiepileptic drug-induced cutaneous adverse drug reactions and HLA-B*1502
genotype in patients from the Hakka population in Meizhou. Methods A total of 214 epileptic patients taking aromatic (n = 94) or non-aromatic
anticonvulsants (n = 120) were included in the study from September 2016 to
May 2018. Clinical data for the patients were analyzed retrospectively and
HLA-B*1502 genotype testing was carried out. Results Thirty patients were HLA-B*1502(+) (14.02%). The proportion of HLA-B*1502(−)
genotype and incidence of adverse drug reactions (ADRs) differed
significantly between the two drug groups. In the aromatic anticonvulsant
group, maculopapular eruption (MPE), Stevens–Johnson syndrome (SJS), toxic
epidermal necrolysis (TEN), and hypersensitivity syndrome (HSS) occurred in
10 patients, including eight HLA-B*1502(+) and two HLA-B*1502(−) patients.
MPE, HSS, SJS, and TEN occurred in 26 patients in the non-aromatic
anticonvulsant group, including one HLA-B*1502(+) and 25 HLA-B*1502(−)
patients. There was a significant correlation between the proportions of
HLA-B*1502(+) genotype and induced cutaneous adverse drug reactions in the
two groups. Conclusions HLA-B*1502 is associated with aromatic anticonvulsant drug-induced cutaneous
adverse drug reactions among the Hakka population in Meizhou, China.
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Affiliation(s)
- Zhiyuan Zheng
- Center for Precision Medicine, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China.,Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China.,Guangdong Provincial Engineering and Technology Research Center for Clinical Molecular Diagnostics and Antibody Therapeutics, Meizhou, P. R. China.,Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China.,Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
| | - Hua Zhong
- Center for Precision Medicine, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China.,Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China.,Guangdong Provincial Engineering and Technology Research Center for Clinical Molecular Diagnostics and Antibody Therapeutics, Meizhou, P. R. China.,Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China.,Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
| | - Qunji Zhang
- Center for Precision Medicine, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China.,Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China.,Guangdong Provincial Engineering and Technology Research Center for Clinical Molecular Diagnostics and Antibody Therapeutics, Meizhou, P. R. China.,Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China.,Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
| | - Qingyan Huang
- Center for Precision Medicine, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China.,Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China.,Guangdong Provincial Engineering and Technology Research Center for Clinical Molecular Diagnostics and Antibody Therapeutics, Meizhou, P. R. China.,Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China.,Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
| | - Heming Wu
- Center for Precision Medicine, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China.,Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China.,Guangdong Provincial Engineering and Technology Research Center for Clinical Molecular Diagnostics and Antibody Therapeutics, Meizhou, P. R. China.,Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China.,Meizhou Municipal Engineering and Technology Research Center for Molecular Diagnostics of Major Genetic Disorders, Meizhou People's Hospital (Huangtang Hospital), Meizhou Academy of Medical Sciences, Meizhou Hospital Affiliated to Sun Yat-sen University, Meizhou, P. R. China
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12
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Suresh NT, E R V, U K. Multi-scale top-down approach for modelling epileptic protein-protein interaction network analysis to identify driver nodes and pathways. Comput Biol Chem 2020; 88:107323. [PMID: 32653778 DOI: 10.1016/j.compbiolchem.2020.107323] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 06/04/2020] [Accepted: 06/23/2020] [Indexed: 12/23/2022]
Abstract
Protein - Protein Interaction Network (PPIN) analysis unveils molecular level mechanisms involved in disease condition. To explore the complex regulatory mechanisms behind epilepsy and to address the clinical and biological issues of epilepsy, in silico techniques are feasible in a cost- effective manner. In this work, a hierarchical procedure to identify influential genes and regulatory pathways in epilepsy prognosis is proposed. To obtain key genes and pathways causing epilepsy, integration of two benchmarked datasets which are exclusively devoted for complex disorders is done as an initial step. Using STRING database, PPIN is constructed for modelling protein-protein interactions. Further, key interactions are obtained from the established PPIN using network centrality measures followed by network propagation algorithm -Random Walk with Restart (RWR). The outcome of the method reveals some influential genes behind epilepsy prognosis, along with their associated pathways like PI3 kinase, VEGF signaling, Ras, Wnt signaling etc. In comparison with similar works, our results have shown improvement in identifying unique molecular functions, biological processes, gene co-occurrences etc. Also, CORUM provides an annotation for approximately 60% of similarity in human protein complexes with the obtained result. We believe that the formulated strategy can put-up the vast consideration of indigenous drugs towards meticulous identification of genes encoded by protein against several combinatorial disorders.
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Affiliation(s)
- Nikhila T Suresh
- Department of Computer Science and IT, Amrita School of Arts and Sciences, Amrita Vishwa Vidyapeetham, Kochi Campus, India
| | - Vimina E R
- Department of Computer Science and IT, Amrita School of Arts and Sciences, Amrita Vishwa Vidyapeetham, Kochi Campus, India.
| | - Krishnakumar U
- Department of Computer Science and IT, Amrita School of Arts and Sciences, Amrita Vishwa Vidyapeetham, Kochi Campus, India
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13
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Chow CY, Absalom N, Biggs K, King GF, Ma L. Venom-derived modulators of epilepsy-related ion channels. Biochem Pharmacol 2020; 181:114043. [PMID: 32445870 DOI: 10.1016/j.bcp.2020.114043] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 05/18/2020] [Indexed: 12/18/2022]
Abstract
Epilepsy is characterised by spontaneous recurrent seizures that are caused by an imbalance between neuronal excitability and inhibition. Since ion channels play fundamental roles in the generation and propagation of action potentials as well as neurotransmitter release at a subset of excitatory and inhibitory synapses, their dysfunction has been linked to a wide variety of epilepsies. Indeed, these unique proteins are the major biological targets for antiepileptic drugs. Selective targeting of a specific ion channel subtype remains challenging for small molecules, due to the high level of homology among members of the same channel family. As a consequence, there is a growing trend to target ion channels with biologics. Venoms are the best known natural source of ion channel modulators, and venom peptides are increasingly recognised as potential therapeutics due to their high selectivity and potency gained through millions of years of evolutionary selection pressure. Here we describe the major ion channel families involved in the pathogenesis of various types of epilepsy, including voltage-gated Na+, K+, Ca2+ channels, Cys-loop receptors, ionotropic glutamate receptors and P2X receptors, and currently available venom-derived peptides that target these channel proteins. Although only a small number of venom peptides have successfully progressed to the clinic, there is reason to be optimistic about their development as antiepileptic drugs, notwithstanding the challenges associated with development of any class of peptide drug.
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Affiliation(s)
- Chun Yuen Chow
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Nathan Absalom
- Brain and Mind Centre, School of Pharmacy, Faculty of Health and Medicine, The University of Sydney, Sydney, NSW 2050, Australia
| | - Kimberley Biggs
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Glenn F King
- Institute for Molecular Bioscience, The University of Queensland, Brisbane, QLD 4072, Australia.
| | - Linlin Ma
- Griffith Institute for Drug Discovery, Griffith University, Nathan, QLD 4111, Australia.
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14
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Li Y, Lv Z, Zhang J, Ma Q, Li Q, Song L, Gong L, Zhu Y, Li X, Hao Y, Yang Y. Profiling of differentially expressed circular RNAs in peripheral blood mononuclear cells from Alzheimer's disease patients. Metab Brain Dis 2020; 35:201-213. [PMID: 31834549 DOI: 10.1007/s11011-019-00497-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Accepted: 09/12/2019] [Indexed: 02/08/2023]
Abstract
Expression of circular RNA (circRNA), a class of noncoding RNAs that regulates gene expression, is altered in Alzheimer's disease. This study profiled differentially expressed circRNAs in peripheral blood mononuclear cells (PBMCs) from five patients with Alzheimer's disease compared to healthy controls using circRNA microarrays. We identified a total of 4060 differentially expressed circRNAs (1990 upregulated and 2070 downregulated) in Alzheimer's disease patients. Among these circRNAs, 10 randomly selected circRNAs were verified using qRT-PCR. The top 10 upregulated and downregulated circRNAs were used to predict their target miRNAs. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses revealed that these differentially expressed circRNAs were strongly associated with inflammation, metabolism, and immune responses, which are all risk factors for Alzheimer's disease. The circRNA-miRNA-mRNA network was most involved in the MAPK, mTOR, AMPK, and WNT signaling pathways in Alzheimer's disease. In conclusion, the current study demonstrated the importance of circRNAs in Alzheimer's disease development. Future studies will evaluate some of these circRNAs as biomarkers for early disease detection and to develop therapeutic strategies to clinically control Alzheimer's disease progression.
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Affiliation(s)
- Yanxin Li
- Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
| | - Zhanyun Lv
- Department of Neurology, The Affiliated Hospital of Jining Medical University, Jining, 272000, China
- Jining Medical University, Jining, 272067, China
| | - Jing Zhang
- Department of Neurology, The Affiliated Hospital of Jining Medical University, Jining, 272000, China
- Jining Medical University, Jining, 272067, China
| | - Qianqian Ma
- Department of Neurology, The Affiliated Hospital of Jining Medical University, Jining, 272000, China
- Jining Medical University, Jining, 272067, China
| | - Qiuhua Li
- Department of Neurology, The Affiliated Hospital of Jining Medical University, Jining, 272000, China
- Jining Medical University, Jining, 272067, China
| | - Li Song
- Department of Neurology, The Affiliated Hospital of Jining Medical University, Jining, 272000, China
- Jining Medical University, Jining, 272067, China
| | - Li Gong
- Department of Neurology, The Affiliated Hospital of Jining Medical University, Jining, 272000, China
- Jining Medical University, Jining, 272067, China
| | - Yunliang Zhu
- Department of Neurology, The Affiliated Hospital of Jining Medical University, Jining, 272000, China
- Jining Medical University, Jining, 272067, China
| | - Xiangyuan Li
- Department of Neurology, The Affiliated Hospital of Jining Medical University, Jining, 272000, China
- Jining Medical University, Jining, 272067, China
| | - Yanlei Hao
- Department of Neurology, The Affiliated Hospital of Jining Medical University, Jining, 272000, China.
- Jining Medical University, Jining, 272067, China.
| | - Yan Yang
- Department of Neurology, The Affiliated Hospital of Jining Medical University, Jining, 272000, China.
- Jining Medical University, Jining, 272067, China.
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15
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Gan J, Cai Q, Galer P, Ma D, Chen X, Huang J, Bao S, Luo R. Mapping the knowledge structure and trends of epilepsy genetics over the past decade: A co-word analysis based on medical subject headings terms. Medicine (Baltimore) 2019; 98:e16782. [PMID: 31393404 PMCID: PMC6709143 DOI: 10.1097/md.0000000000016782] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Over the past 10 years, epilepsy genetics has made dramatic progress. This study aimed to analyze the knowledge structure and the advancement of epilepsy genetics over the past decade based on co-word analysis of medical subject headings (MeSH) terms. METHODS Scientific publications focusing on epilepsy genetics from the PubMed database (January 2009-December 2018) were retrieved. Bibliometric information was analyzed quantitatively using Bibliographic Item Co-Occurrence Matrix Builder (BICOMB) software. A knowledge social network analysis and publication trend based on the high-frequency MeSH terms was built using VOSviewer. RESULTS According to the search strategy, a total of 5185 papers were included. Among all the extracted MeSH terms, 86 high-frequency MeSH terms were identified. Hot spots were clustered into 5 categories including: "ion channel diseases," "beyond ion channel diseases," "experimental research & epigenetics," "single nucleotide polymorphism & pharmacogenetics," and "genetic techniques". "Epilepsy," "mutation," and "seizures," were located at the center of the knowledge network. "Ion channel diseases" are typically in the most prominent position of epilepsy genetics research. "Beyond ion channel diseases" and "genetic techniques," however, have gradually grown into research cores and trends, such as "intellectual disability," "infantile spasms," "phenotype," "exome," " deoxyribonucleic acid (DNA) copy number variations," and "application of next-generation sequencing." While ion channel genes such as "SCN1A," "KCNQ2," "SCN2A," "SCN8A" accounted for nearly half of epilepsy genes in MeSH terms, a number of additional beyond ion channel genes like "CDKL5," "STXBP1," "PCDH19," "PRRT2," "LGI1," "ALDH7A1," "MECP2," "EPM2A," "ARX," "SLC2A1," and more were becoming increasingly popular. In contrast, gene therapies, treatment outcome, and genotype-phenotype correlations were still in their early stages of research. CONCLUSION This co-word analysis provides an overview of epilepsy genetics research over the past decade. The 5 research categories display publication hot spots and trends in epilepsy genetics research which could consequently supply some direction for geneticists and epileptologists when launching new projects.
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Affiliation(s)
- Jing Gan
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, China
| | - Qianyun Cai
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, China
| | - Peter Galer
- Department of Biomedical and Health Informatics, The Children's Hospital of Philadelphia, PA
| | - Dan Ma
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu
| | - Xiaolu Chen
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu
| | - Jichong Huang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, China
| | - Shan Bao
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University) Ministry of Education, China
| | - Rong Luo
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu
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Mohandas N, Loke YJ, Hopkins S, Mackenzie L, Bennett C, Berkovic SF, Vadlamudi L, Craig JM. Evidence for type-specific DNA methylation patterns in epilepsy: a discordant monozygotic twin approach. Epigenomics 2019; 11:951-968. [DOI: 10.2217/epi-2018-0136] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Aim: Epilepsy is a common neurological disorder characterized by recurrent seizures. We performed epigenetic analyses between and within 15 monozygotic (MZ) twin pairs discordant for focal or generalized epilepsy. Methods: DNA methylation analysis was performed using Illumina Infinium MethylationEPIC arrays, in blood and buccal samples. Results: Differentially methylated regions between epilepsy types associated with PM20D1 and GFPT2 genes in both tissues. Within MZ discordant twin pairs, differentially methylated regions associated with OTX1 and ARID5B genes for generalized epilepsy and TTC39C and DLX5 genes for focal epilepsy. Conclusion: This is the first epigenome-wide association study, utilizing the discordant MZ co-twin model, to deepen our understanding of the neurobiology of epilepsy.
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Affiliation(s)
- Namitha Mohandas
- Environmental & Genetic Epidemiology Research, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Flemington Road, Parkville, Victoria, Australia
| | - Yuk Jing Loke
- Environmental & Genetic Epidemiology Research, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia
| | - Stephanie Hopkins
- Environmental & Genetic Epidemiology Research, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia
- School of Medicine & Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Lisa Mackenzie
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Queensland, Australia
| | - Carmen Bennett
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Queensland, Australia
| | - Samuel F Berkovic
- Epilepsy Research Centre, University of Melbourne, Austin Health, Victoria, Australia
| | - Lata Vadlamudi
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Queensland, Australia
- Royal Brisbane & Women's Hospital, Queensland, Australia
| | - Jeffrey M Craig
- Environmental & Genetic Epidemiology Research, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Flemington Road, Parkville, Victoria, Australia
- Centre for Molecular & Medical Research, School of Medicine, Deakin University, Geelong, Victoria 3220, Australia
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Aref-Eshghi E, Bend EG, Colaiacovo S, Caudle M, Chakrabarti R, Napier M, Brick L, Brady L, Carere DA, Levy MA, Kerkhof J, Stuart A, Saleh M, Beaudet AL, Li C, Kozenko M, Karp N, Prasad C, Siu VM, Tarnopolsky MA, Ainsworth PJ, Lin H, Rodenhiser DI, Krantz ID, Deardorff MA, Schwartz CE, Sadikovic B. Diagnostic Utility of Genome-wide DNA Methylation Testing in Genetically Unsolved Individuals with Suspected Hereditary Conditions. Am J Hum Genet 2019; 104:685-700. [PMID: 30929737 DOI: 10.1016/j.ajhg.2019.03.008] [Citation(s) in RCA: 107] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 03/05/2019] [Indexed: 12/13/2022] Open
Abstract
Conventional genetic testing of individuals with neurodevelopmental presentations and congenital anomalies (ND/CAs), i.e., the analysis of sequence and copy number variants, leaves a substantial proportion of them unexplained. Some of these cases have been shown to result from DNA methylation defects at a single locus (epi-variants), while others can exhibit syndrome-specific DNA methylation changes across multiple loci (epi-signatures). Here, we investigate the clinical diagnostic utility of genome-wide DNA methylation analysis of peripheral blood in unresolved ND/CAs. We generate a computational model enabling concurrent detection of 14 syndromes using DNA methylation data with full accuracy. We demonstrate the ability of this model in resolving 67 individuals with uncertain clinical diagnoses, some of whom had variants of unknown clinical significance (VUS) in the related genes. We show that the provisional diagnoses can be ruled out in many of the case subjects, some of whom are shown by our model to have other diseases initially not considered. By applying this model to a cohort of 965 ND/CA-affected subjects without a previous diagnostic assumption and a separate assessment of rare epi-variants in this cohort, we identify 15 case subjects with syndromic Mendelian disorders, 12 case subjects with imprinting and trinucleotide repeat expansion disorders, as well as 106 case subjects with rare epi-variants, a portion of which involved genes clinically or functionally linked to the subjects' phenotypes. This study demonstrates that genomic DNA methylation analysis can facilitate the molecular diagnosis of unresolved clinical cases and highlights the potential value of epigenomic testing in the routine clinical assessment of ND/CAs.
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Thijs RD, Surges R, O'Brien TJ, Sander JW. Epilepsy in adults. Lancet 2019; 393:689-701. [PMID: 30686584 DOI: 10.1016/s0140-6736(18)32596-0] [Citation(s) in RCA: 902] [Impact Index Per Article: 180.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 09/08/2018] [Accepted: 10/11/2018] [Indexed: 12/11/2022]
Abstract
Epilepsy is one of the most common serious brain conditions, affecting over 70 million people worldwide. Its incidence has a bimodal distribution with the highest risk in infants and older age groups. Progress in genomic technology is exposing the complex genetic architecture of the common types of epilepsy, and is driving a paradigm shift. Epilepsy is a symptom complex with multiple risk factors and a strong genetic predisposition rather than a condition with a single expression and cause. These advances have resulted in the new classification of epileptic seizures and epilepsies. A detailed clinical history and a reliable eyewitness account of a seizure are the cornerstones of the diagnosis. Ancillary investigations can help to determine cause and prognosis. Advances in brain imaging are helping to identify the structural and functional causes and consequences of the epilepsies. Comorbidities are increasingly recognised as important aetiological and prognostic markers. Antiseizure medication might suppress seizures in up to two-thirds of all individuals but do not alter long-term prognosis. Epilepsy surgery is the most effective way to achieve long-term seizure freedom in selected individuals with drug-resistant focal epilepsy, but it is probably not used enough. With improved understanding of the gradual development of epilepsy, epigenetic determinants, and pharmacogenomics comes the hope for better, disease-modifying, or even curative, pharmacological and non-pharmacological treatment strategies. Other developments are clinical implementation of seizure detection devices and new neuromodulation techniques, including responsive neural stimulation.
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Affiliation(s)
- Roland D Thijs
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands; Department of Neurology, Leiden University Medical Centre, Leiden, Netherlands; NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK
| | - Rainer Surges
- Section of Epileptology, Department of Neurology, University Hospital RWTH Aachen, Germany
| | - Terence J O'Brien
- Melbourne Brain Centre, Departments of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, VIC, Australia; Departments of Neuroscience and Neurology, Central Clinical School, Monash University, The Alfred Hospital, Melbourne, VIC, Australia
| | - Josemir W Sander
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, Netherlands; NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK; Chalfont Centre for Epilepsy, Chalfont St Peter, UK.
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19
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Sun Y, Seneviratne U, Perucca P, Chen Z, Kee MT, O'Brien TJ, D'Souza W, Kwan P. Generalized polyspike train: An EEG biomarker of drug-resistant idiopathic generalized epilepsy. Neurology 2018; 91:e1822-e1830. [PMID: 30315071 DOI: 10.1212/wnl.0000000000006472] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 08/01/2018] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To identify clinical and EEG biomarkers of drug resistance in adults with idiopathic generalized epilepsy. METHODS We conducted a case-control study consisting of a discovery cohort and a replication cohort independently assessed at 2 different centers. In each center, patients with the idiopathic generalized epilepsy phenotype and generalized spike-wave discharges on EEG were classified as drug-resistant or drug-responsive. EEG changes were classified into predefined patterns and compared between the 2 groups in the discovery cohort. Factors associated with drug resistance in multivariable analysis were tested in the replication cohort. RESULTS The discovery cohort included 85 patients (29% drug-resistant and 71% drug-responsive). Their median age at assessment was 32 years and 50.6% were female. Multivariable analysis showed that higher number of seizure types ever experienced (3 vs 1: odds ratio [OR] = 31.1, 95% confidence interval [CI]: 4.5-214, p < 0.001; 3 vs 2: OR = 14.6, 95% CI: 2.3-93.1, p = 0.004) and generalized polyspike train (burst of generalized rhythmic spikes lasting less than 1 second) during sleep were associated with drug resistance (OR = 10.8, 95% CI: 2.4-49.4, p = 0.002). When these factors were tested in the replication cohort of 80 patients (27.5% drug-resistant and 72.5% drug-responsive; 71.3% female; median age 27.5 years), the proportion of patients with generalized polyspike train during sleep was also higher in the drug-resistant group (OR = 4.0, 95% CI: 1.35-11.8, p = 0.012). CONCLUSION Generalized polyspike train during sleep may be an EEG biomarker for drug resistance in adults with idiopathic generalized epilepsy.
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Affiliation(s)
- Yanping Sun
- From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia
| | - Udaya Seneviratne
- From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia
| | - Piero Perucca
- From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia
| | - Zhibin Chen
- From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia
| | - Meng Tan Kee
- From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia
| | - Terence J O'Brien
- From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia.
| | - Wendyl D'Souza
- From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia
| | - Patrick Kwan
- From the Department of Neurology (Y.S.), The Affiliated Hospital of Qingdao University, Qingdao, China; Department of Neurology (Y.S.), Xuanwu Hospital, Capital Medical University, Beijing, China; Departments of Neurology (Y.S., P.P., M.K.T., T.J.O., P.K.) and Medicine (P.P., Z.C., T.J.O., P.K.), The Royal Melbourne Hospital, The University of Melbourne, Victoria; Department of Medicine (U.S., W.D.), St. Vincent's Hospital Melbourne, The University of Melbourne, Victoria; Department of Medicine, The School of Clinical Sciences at Monash Health (U.S.), and Departments of Neuroscience, The Central Clinical School (P.P., T.J.O., P.K.), Monash University, Victoria; and Department of Neurology (P.P., T.J.O., P.K.), The Alfred Hospital, Victoria, Australia.
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Vargas-Sánchez K, Mogilevskaya M, Rodríguez-Pérez J, Rubiano MG, Javela JJ, González-Reyes RE. Astroglial role in the pathophysiology of status epilepticus: an overview. Oncotarget 2018; 9:26954-26976. [PMID: 29928494 PMCID: PMC6003549 DOI: 10.18632/oncotarget.25485] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 05/09/2018] [Indexed: 12/11/2022] Open
Abstract
Status epilepticus is a medical emergency with elevated morbidity and mortality rates, and represents a leading cause of epilepsy-related deaths. Though status epilepticus can occur at any age, it manifests more likely in children and elderly people. Despite the common prevalence of epileptic disorders, a complete explanation for the mechanisms leading to development of self-limited or long lasting seizures (as in status epilepticus) are still lacking. Apart from neurons, research evidence suggests the involvement of immune and glial cells in epileptogenesis. Among glial cells, astrocytes represent an ideal target for the study of the pathophysiology of status epilepticus, due to their key role in homeostatic balance of the central nervous system. During status epilepticus, astroglial cells are activated by the presence of cytokines, damage associated molecular patterns and reactive oxygen species. The persistent activation of astrocytes leads to a decrease in glutamate clearance with a corresponding accumulation in the synaptic extracellular space, increasing the chance of neuronal excitotoxicity. Moreover, major alterations in astrocytic gap junction coupling, inflammation and receptor expression, facilitate the generation of seizures. Astrocytes are also involved in dysregulation of inhibitory transmission in the central nervous system and directly participate in ionic homeostatic alterations during status epilepticus. In the present review, we focus on the functional and structural changes in astrocytic activity that participate in the development and maintenance of status epilepticus, with special attention on concurrent inflammatory alterations. We also include potential astrocytic treatment targets for status epilepticus.
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Affiliation(s)
- Karina Vargas-Sánchez
- Biomedical Sciences Research Group, School of Medicine, Universidad Antonio Nariño, Bogotá, Colombia
| | | | - John Rodríguez-Pérez
- Biomedical Sciences Research Group, School of Medicine, Universidad Antonio Nariño, Bogotá, Colombia
| | - María G Rubiano
- Biomedical Sciences Research Group, School of Medicine, Universidad Antonio Nariño, Bogotá, Colombia
| | - José J Javela
- Grupo de Clínica y Salud Mental, Programa de Psicología, Universidad Católica de Pereira, Pereira, Colombia
| | - Rodrigo E González-Reyes
- Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, GI en Neurociencias-NeURos, Bogotá, Colombia
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Genetics of Epilepsy in the Era of Precision Medicine: Implications for Testing, Treatment, and Genetic Counseling. CURRENT GENETIC MEDICINE REPORTS 2018. [DOI: 10.1007/s40142-018-0139-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Lee EH. Epilepsy syndromes during the first year of life and the usefulness of an epilepsy gene panel. KOREAN JOURNAL OF PEDIATRICS 2018; 61:101-107. [PMID: 29713355 PMCID: PMC5924840 DOI: 10.3345/kjp.2018.61.4.101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 03/24/2018] [Accepted: 03/28/2018] [Indexed: 01/25/2023]
Abstract
Recent advances in genetics have determined that a number of epilepsy syndromes that occur in the first year of life are associated with genetic etiologies. These syndromes range from benign familial epilepsy syndromes to early-onset epileptic encephalopathies that lead to poor prognoses and severe psychomotor retardation. An early genetic diagnosis can save time and overall cost by reducing the amount of time and resources expended to reach a diagnosis. Furthermore, a genetic diagnosis can provide accurate prognostic information and, in certain cases, enable targeted therapy. Here, several early infantile epilepsy syndromes with strong genetic associations are briefly reviewed, and their genotype-phenotype correlations are summarized. Because the clinical presentations of these disorders frequently overlap and have heterogeneous genetic causes, next-generation sequencing (NGS)-based gene panel testing represents a more powerful diagnostic tool than single gene testing. As genetic information accumulates, genetic testing will likely play an increasingly important role in diagnosing pediatric epilepsy. However, the efforts of clinicians to classify phenotypes in nondiagnosed patients and improve their ability to interpret genetic variants remain important in the NGS era.
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Affiliation(s)
- Eun Hye Lee
- Department of Pediatrics, College of Medicine, Kyung Hee University, Seoul, Korea
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Savic I, Engel J. Reprint of "Structural and functional correlates of epileptogenesis--does gender matter?". Neurobiol Dis 2018; 72 Pt B:131-5. [PMID: 25448763 DOI: 10.1016/j.nbd.2014.10.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2014] [Revised: 05/15/2014] [Accepted: 05/22/2014] [Indexed: 11/30/2022] Open
Abstract
In the majority of neuropsychiatric conditions, marked gender-based differences have been found in the epidemiology,clinical manifestations, and therapy of disease. One possible reason is that sex differences in cerebral morphology, structural and functional connections, render men and women differentially vulnerable to various disease processes. The present review addresses this issue with respect to the functional and structural correlates to some forms of epilepsy.
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Afawi Z, Gamirova RG, Jaxybayeva AK, Esin RG. Modern achievements in genetic studies of idiopathic generalized epilepsies. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:56-60. [DOI: 10.17116/jnevro201811810256] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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HRPU-2, a Homolog of Mammalian hnRNP U, Regulates Synaptic Transmission by Controlling the Expression of SLO-2 Potassium Channel in Caenorhabditis elegans. J Neurosci 2017; 38:1073-1084. [PMID: 29217678 DOI: 10.1523/jneurosci.1991-17.2017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 11/27/2017] [Accepted: 12/02/2017] [Indexed: 12/22/2022] Open
Abstract
Slo2 channels are large-conductance potassium channels abundantly expressed in the nervous system. However, it is unclear how their expression level in neurons is regulated. Here we report that HRPU-2, an RNA-binding protein homologous to mammalian heterogeneous nuclear ribonucleoprotein U (hnRNP U), plays an important role in regulating the expression of SLO-2 (a homolog of mammalian Slo2) in Caenorhabditis elegans Loss-of-function (lf) mutants of hrpu-2 were isolated in a genetic screen for suppressors of a sluggish phenotype caused by a hyperactive SLO-2. In hrpu-2(lf) mutants, SLO-2-mediated delayed outward currents in neurons are greatly decreased, and neuromuscular synaptic transmission is enhanced. These mutant phenotypes can be rescued by expressing wild-type HRPU-2 in neurons. HRPU-2 binds to slo-2 mRNA, and hrpu-2(lf) mutants show decreased SLO-2 protein expression. In contrast, hrpu-2(lf) does not alter the expression of either the BK channel SLO-1 or the Shaker type potassium channel SHK-1. hrpu-2(lf) mutants are indistinguishable from wild type in gross motor neuron morphology and locomotion behavior. Together, these observations suggest that HRPU-2 plays important roles in SLO-2 function by regulating SLO-2 protein expression, and that SLO-2 is likely among a restricted set of proteins regulated by HRPU-2. Mutations of human Slo2 channel and hnRNP U are strongly linked to epileptic disorders and intellectual disability. The findings of this study suggest a potential link between these two molecules in human patients.SIGNIFICANCE STATEMENT Heterogeneous nuclear ribonucleoprotein U (hnRNP U) belongs to a family of RNA-binding proteins that play important roles in controlling gene expression. Recent studies have established a strong link between mutations of hnRNP U and human epilepsies and intellectual disability. However, it is unclear how mutations of hnRNP U may cause such disorders. This study shows that mutations of HRPU-2, a worm homolog of mammalian hnRNP U, result in dysfunction of a Slo2 potassium channel, which is critical to neuronal function. Because mutations of Slo2 channels are also strongly associated with epileptic encephalopathies and intellectual disability in humans, the findings of this study point to a potential mechanism underlying neurological disorders caused by hnRNP U mutations.
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Azimi T, Ghafouri-Fard S, Davood Omrani M, Mazdeh M, Arsang-Jang S, Sayad A, Taheri M. Vaccinia Related Kinase 2 (VRK2) expression in neurological disorders: schizophrenia, epilepsy and multiple sclerosis. Mult Scler Relat Disord 2017; 19:15-19. [PMID: 29100046 DOI: 10.1016/j.msard.2017.10.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Revised: 09/19/2017] [Accepted: 10/23/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Schizophrenia (SCZ), epilepsy and Multiple Sclerosis (MS) are neurological disorders with increasing prevalence disturb the patients' lives and are regarded as burdens to the society. As multifactorial disorders, genetic susceptibility factors are involved in their pathogenesis. The Vaccinia-Related Kinase 2 (VRK2) gene codes for a serine threonine kinase recently reported to be contributed in the pathogenesis of some neurological disorders. In the present case-control study we compared the VRK2 gene expression in peripheral blood samples from SCZ, epilepsy and MS patients with normal subjects. METHOD A total of 300 subjects comprising 50 patients in each disease category (SCZ, epilepsy and MS) as well as 150 healthy individuals (50 matched controls for each disorder) participated in the current study. RESULT The VRK2 blood mRNA expression level was measured using the TaqMan real time PCR. The results demonstrated significant down-regulation of VRK2 gene in SCZ (P<0.0001), epilepsy (P=0.008) and MS (P=0.029) compared with the healthy subjects. CONCLUSION Consequently, VRK2 is suggested as a candidate gene for neurological disorders through its role in signaling pathway, the neuronal loss and stress response.
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Affiliation(s)
- Tahereh Azimi
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, PO Box 1985717443, Tehran, Iran
| | - Soudeh Ghafouri-Fard
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, PO Box 1985717443, Tehran, Iran
| | - Mir Davood Omrani
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, PO Box 1985717443, Tehran, Iran; Urogenital Stem Cell Research Center, Shahid Labbafi Nejad Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehrdokht Mazdeh
- Department of Neurology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Shahram Arsang-Jang
- Department of Epidemiology and Biostatistics, Faculty of Health, Qom University of Medical Sciences, Qom, Iran
| | - Arezou Sayad
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, PO Box 1985717443, Tehran, Iran.
| | - Mohammad Taheri
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, PO Box 1985717443, Tehran, Iran; Urogenital Stem Cell Research Center, Shahid Labbafi Nejad Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Torres CM, Siebert M, Bock H, Mota SM, Krammer BR, Duarte JÁ, Bragatti JA, Castan JU, de Castro LA, Saraiva-Pereira ML, Bianchin MM. NTRK2 (TrkB gene) variants and temporal lobe epilepsy: A genetic association study. Epilepsy Res 2017; 137:1-8. [PMID: 28863320 DOI: 10.1016/j.eplepsyres.2017.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 08/14/2017] [Accepted: 08/19/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The NTRK2 gene encodes a member of the neurotrophic tyrosine kinase receptor family known as TrkB. It is a membrane-associated receptor with signaling and cellular differentiation properties that has been involved in neuropsychiatric disorders, including epilepsy. We report here the frequencies of NTRK2 allele variants in patients with temporal lobe epilepsy (TLE) compared to controls without epilepsy and explore the impact of these polymorphisms on major clinical variables in TLE. METHODS A case-control study comparing the frequencies of the NTRK2 gene polymorphisms beween 198 TLE Caucasian patients and 200 matching controls without epilepsy. In a second step, the impact of allelic variation on major clinical and electroencephalographic epilepsy variables was evaluated in the group of TLE patients. The following polymorphisms were determined by testing different regions of the NTRK2 gene: rs1867283, rs10868235, rs1147198, rs11140800, rs1187286, rs2289656, rs1624327, rs1443445, rs3780645, and rs2378672. To correct for multiple correlations the level of significance was set at p<0.01. RESULTS Patients with TLE showed a statistical trend for increase of the T/T genotype in rs10868235 compared to control (O.R.=1.90; 95%CI=1.17-3.09; p=0.01). Homozygous patients for the A allele in rs1443445 had earlier mean age at onset of seizures, p=0.009 (mean age of 16.6 versus 22.4years). We also observed that the T allele in rs3780645 was more frequent in patients who needed polytheraphy for seizure control than in patients on monotherapy, (O.R.=4.13; 95%CI=1.68-10.29; p=0.001). This finding may reflect an increased difficulty to obtain seizure control in this group of patients. No additional differences were observed in this study. CONCLUSIONS Patients with epilepsy showed a trend for a difference in rs10868235 allelic distribution compared to controls without epilepsy. NTRK2 variability influenced age at seizure onset and the pharmacological response to seizure control. As far as we know, this is the first study showing an association between NTKR2 allelic variants in human epilepsy. We believe that further studies in this venue will shade some light on the molecular mechanisms involved in epileptogenesis and in the clinical characteristics of epilepsy.
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Affiliation(s)
- Carolina Machado Torres
- Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul, Brazil; Basic Research and Advanced Investigations in Neurology (BRAIN), Experimental Research Centre, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; Centro de Tratamento de Epilepsia Refratária (CETER), Hospital de Clínicas de Porto Alegre, Brazil; Division of Neurology, Hospital de Clínicas de Porto Alegre, Brazil
| | - Marina Siebert
- Laboratory of Genetic Identification, Experimental Research Centre, Hospital de Clinicas de Porto Alegre, Brazil
| | - Hugo Bock
- Laboratory of Genetic Identification, Experimental Research Centre, Hospital de Clinicas de Porto Alegre, Brazil
| | - Suelen Mandelli Mota
- Basic Research and Advanced Investigations in Neurology (BRAIN), Experimental Research Centre, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - Bárbara Reis Krammer
- Basic Research and Advanced Investigations in Neurology (BRAIN), Experimental Research Centre, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - Juliana Ávila Duarte
- Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul, Brazil; Centro de Tratamento de Epilepsia Refratária (CETER), Hospital de Clínicas de Porto Alegre, Brazil
| | - José Augusto Bragatti
- Centro de Tratamento de Epilepsia Refratária (CETER), Hospital de Clínicas de Porto Alegre, Brazil; Division of Neurology, Hospital de Clínicas de Porto Alegre, Brazil
| | - Juliana Unis Castan
- Centro de Tratamento de Epilepsia Refratária (CETER), Hospital de Clínicas de Porto Alegre, Brazil; Division of Neurology, Hospital de Clínicas de Porto Alegre, Brazil
| | - Luiza Amaral de Castro
- Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul, Brazil; Basic Research and Advanced Investigations in Neurology (BRAIN), Experimental Research Centre, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil
| | - Maria Luiza Saraiva-Pereira
- Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul, Brazil; Basic Research and Advanced Investigations in Neurology (BRAIN), Experimental Research Centre, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; Laboratory of Genetic Identification, Experimental Research Centre, Hospital de Clinicas de Porto Alegre, Brazil
| | - Marino Muxfeldt Bianchin
- Graduate Program in Medical Science, Universidade Federal do Rio Grande do Sul, Brazil; Basic Research and Advanced Investigations in Neurology (BRAIN), Experimental Research Centre, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; Centro de Tratamento de Epilepsia Refratária (CETER), Hospital de Clínicas de Porto Alegre, Brazil; Division of Neurology, Hospital de Clínicas de Porto Alegre, Brazil.
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Weber YG, Biskup S, Helbig KL, Von Spiczak S, Lerche H. The role of genetic testing in epilepsy diagnosis and management. Expert Rev Mol Diagn 2017; 17:739-750. [PMID: 28548558 DOI: 10.1080/14737159.2017.1335598] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
INTRODUCTION Epilepsy is a common neurological disorder characterized by recurrent unprovoked seizures. More than 500 epilepsy-associated genes have been described in the literature. Most of these genes play an important role in neuronal excitability, cortical development or synaptic transmission. A growing number of genetic variations have implications on diagnosis and prognostic or therapeutic advice in terms of a personalized medicine. Area covered: The review presents the different forms of genetic epilepsies with respect to their underlying genetic and functional pathophysiology and aims to give advice for recommended genetic testing. Moreover, it discusses ethical and legal guidelines, costs and technical limitations which should be considered. Expert commentary: Genetic testing is an important component in the diagnosis and treatment of many forms of epilepsy.
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Affiliation(s)
- Yvonne G Weber
- a Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research , University of Tübingen , Tubingen , Germany
| | - Saskia Biskup
- b CeGaT GmbH , Center for Genomics and Transcriptomics , Tübingen , Germany
| | - Katherine L Helbig
- c Division of Clinical Genomics , Ambry Genetics , Aliso Viejo , CA , USA
| | - Sarah Von Spiczak
- d Department of Neuropediatrics , University Medical Center Schleswig-Holstein, Christian Albrechts University , Kiel , Germany.,e Northern German Epilepsy Center for Children and Adolescents , Schwentinental-Raisdorf , Germany
| | - Holger Lerche
- a Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research , University of Tübingen , Tubingen , Germany
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Wang S, Li L, Tao R, Gao Y. Ion channelopathies associated genetic variants as the culprit for sudden unexplained death. Forensic Sci Int 2017; 275:128-137. [PMID: 28363160 DOI: 10.1016/j.forsciint.2017.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 02/23/2017] [Accepted: 03/13/2017] [Indexed: 11/29/2022]
Abstract
Forensic identification of sudden unexplained death (SUD) has always been a ticklish issue because it used to be defined as sudden death without a conclusive diagnosis after autopsy. However, benefiting from the developments in genome research, a growing body of evidence points to the importance of ion channelopathies associated genetic variants in the pathogenesis of SUD. Genetic diagnosis of the deceased is also a new trend in epidemiological studies, for it enables the undertaking for preventive approach in individuals with high risks. In this review, we briefly discuss the molecular structure of ion channels and the role of genetic variants in regulating their functions as well as the diverse mechanisms underlying the ion channelopathies at gene level.
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Affiliation(s)
- Shouyu Wang
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou 215123, Jiangsu, China
| | - Lijuan Li
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou 215123, Jiangsu, China
| | - Ruiyang Tao
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou 215123, Jiangsu, China
| | - Yuzhen Gao
- Department of Forensic Medicine, Medical College of Soochow University, Suzhou 215123, Jiangsu, China.
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30
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Smith LA, Ullmann JFP, Olson HE, El Achkar CM, Truglio G, Kelly M, Rosen-Sheidley B, Poduri A. A Model Program for Translational Medicine in Epilepsy Genetics. J Child Neurol 2017; 32:429-436. [PMID: 28056630 PMCID: PMC5625332 DOI: 10.1177/0883073816685654] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Recent technological advances in gene sequencing have led to a rapid increase in gene discovery in epilepsy. However, the ability to assess pathogenicity of variants, provide functional analysis, and develop targeted therapies has not kept pace with rapid advances in sequencing technology. Thus, although clinical genetic testing may lead to a specific molecular diagnosis for some patients, test results often lead to more questions than answers. As the field begins to focus on therapeutic applications of genetic diagnoses using precision medicine, developing processes that offer more than equivocal test results is essential. The success of precision medicine in epilepsy relies on establishing a correct genetic diagnosis, analyzing functional consequences of genetic variants, screening potential therapeutics in the preclinical laboratory setting, and initiating targeted therapy trials for patients. The authors describe the structure of a comprehensive, pediatric Epilepsy Genetics Program that can serve as a model for translational medicine in epilepsy.
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Affiliation(s)
- Lacey A. Smith
- Epilepsy Genetics Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
| | - Jeremy F. P. Ullmann
- Epilepsy Genetics Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
| | - Heather E. Olson
- Epilepsy Genetics Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Christelle M. El Achkar
- Epilepsy Genetics Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
| | - Gessica Truglio
- Epilepsy Genetics Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
| | - McKenna Kelly
- Epilepsy Genetics Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
| | - Beth Rosen-Sheidley
- Epilepsy Genetics Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
| | - Annapurna Poduri
- Epilepsy Genetics Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
- F.M. Kirby Neurobiology Center, Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
- Department of Neurology, Harvard Medical School, Boston, MA, USA
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31
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Abstract
This review is a summary of a talk presented at the 2015 American Epilepsy Society Annual Meeting. Its purposes are 1) to review developments in epilepsy genetics, 2) to discuss which groups of patients with epilepsy might benefit from genetic testing, and 3) to present a rational approach to genetic testing in epilepsy in the rapidly evolving era of genomic medicine.
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32
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Reid CA, Hildebrand MS, Mullen SA, Hildebrand JM, Berkovic SF, Petrou S. Synaptic Zn 2+ and febrile seizure susceptibility. Br J Pharmacol 2016; 174:119-125. [PMID: 27771943 DOI: 10.1111/bph.13658] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Revised: 10/11/2016] [Accepted: 10/17/2016] [Indexed: 12/20/2022] Open
Abstract
Zn2+ , the second most prevalent trace element in the body, is essential for supporting a wide range of biological functions. While the majority of Zn2+ in the brain is protein-bound, a significant proportion of free Zn2+ is found co-localized with glutamate in synaptic vesicles and is released in an activity-dependent manner. Clinical studies have shown Zn2+ levels are significantly lower in blood and cerebrospinal fluid of children that suffer febrile seizures. Likewise, investigations in multiple animal models demonstrate that low levels of brain Zn2+ increase seizure susceptibility. Recent work provides human genetic evidence that disruption of brain Zn2+ homeostasis at the level of the synapse is associated with increased seizure susceptibility. In this review, we have explored the clinical, functional and genetic data supporting the view that low synaptic Zn2+ increases cellular excitability and febrile seizure susceptibility. Finally, the review focuses on the potential of therapeutic Zn2+ supplementation for at risk patients.
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Affiliation(s)
- Christopher A Reid
- Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Michael S Hildebrand
- Epilepsy Research Centre, Department of Medicine, University of Melbourne, Austin Health, Heidelberg, VIC, Australia
| | - Saul A Mullen
- Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
| | - Joanne M Hildebrand
- Cell Signalling and Cell Death Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, VIC, Australia.,Department of Medical Biology, University of Melbourne, Parkville, VIC, Australia
| | - Samuel F Berkovic
- Epilepsy Research Centre, Department of Medicine, University of Melbourne, Austin Health, Heidelberg, VIC, Australia
| | - Steven Petrou
- Florey Institute for Neuroscience and Mental Health, The University of Melbourne, Parkville, VIC, Australia
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Helbig KL, Hedrich UBS, Shinde DN, Krey I, Teichmann AC, Hentschel J, Schubert J, Chamberlin AC, Huether R, Lu HM, Alcaraz WA, Tang S, Jungbluth C, Dugan SL, Vainionpää L, Karle KN, Synofzik M, Schöls L, Schüle R, Lehesjoki AE, Helbig I, Lerche H, Lemke JR. A recurrent mutation in KCNA2 as a novel cause of hereditary spastic paraplegia and ataxia. Ann Neurol 2016; 80. [PMID: 27543892 PMCID: PMC5129488 DOI: 10.1002/ana.24762] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 08/02/2016] [Accepted: 08/14/2016] [Indexed: 01/30/2023]
Abstract
The hereditary spastic paraplegias (HSPs) are heterogeneous neurodegenerative disorders with over 50 known causative genes. We identified a recurrent mutation in KCNA2 (c.881G>A, p.R294H), encoding the voltage-gated K(+) -channel, KV 1.2, in two unrelated families with HSP, intellectual disability (ID), and ataxia. Follow-up analysis of > 2,000 patients with various neurological phenotypes identified a de novo p.R294H mutation in a proband with ataxia and ID. Two-electrode voltage-clamp recordings of Xenopus laevis oocytes expressing mutant KV 1.2 channels showed loss of function with a dominant-negative effect. Our findings highlight the phenotypic spectrum of a recurrent KCNA2 mutation, implicating ion channel dysfunction as a novel HSP disease mechanism. Ann Neurol 2016.
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Affiliation(s)
| | - Ulrike B S Hedrich
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | | | - Ilona Krey
- Institute of Human Genetics, University of Leipzig Hospitals and Clinics, Leipzig, Germany
| | | | - Julia Hentschel
- Institute of Human Genetics, University of Leipzig Hospitals and Clinics, Leipzig, Germany
| | - Julian Schubert
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | | | - Robert Huether
- Department of Bioinformatics, Ambry Genetics, Aliso Viejo, CA
| | - Hsiao-Mei Lu
- Department of Bioinformatics, Ambry Genetics, Aliso Viejo, CA
| | - Wendy A Alcaraz
- Division of Clinical Genomics, Ambry Genetics, Aliso Viejo, CA
| | - Sha Tang
- Division of Clinical Genomics, Ambry Genetics, Aliso Viejo, CA
| | - Chelsy Jungbluth
- Department of Medical Genetics, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN
| | - Sarah L Dugan
- Department of Medical Genetics, Children's Hospitals and Clinics of Minnesota, Minneapolis, MN.,Division of Medical Genetics, University of Utah, Salt Lake City, UT
| | - Leena Vainionpää
- Department of Pediatrics and Adolescence, Oulu University Hospital, PEDEGO Research Unit, University of Oulu, Oulu, Finland
| | - Kathrin N Karle
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany.,Department of Psychiatry and Psychotherapy, University of Tübingen, Tübingen, Germany
| | - Matthis Synofzik
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Ludger Schöls
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Rebecca Schüle
- Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany.,German Center for Neurodegenerative Diseases (DZNE), Tübingen, Germany
| | - Anna-Elina Lehesjoki
- Folkhälsan Institute of Genetics, Helsinki, Finland; Research Programs Unit, Molecular Neurology and Neuroscience Center, University of Helsinki, Helsinki, Finland
| | - Ingo Helbig
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, PA.,Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Holger Lerche
- Department of Neurology and Epileptology, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany
| | - Johannes R Lemke
- Institute of Human Genetics, University of Leipzig Hospitals and Clinics, Leipzig, Germany.
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Ghasemi M, Hadipour-Niktarash A. Pathologic role of neuronal nicotinic acetylcholine receptors in epileptic disorders: implication for pharmacological interventions. Rev Neurosci 2016; 26:199-223. [PMID: 25565544 DOI: 10.1515/revneuro-2014-0044] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 10/16/2014] [Indexed: 12/30/2022]
Abstract
Accumulating evidence suggests that neuronal nicotinic acetylcholine receptors (nAChRs) may play a key role in the pathophysiology of some neurological diseases such as epilepsy. Based on genetic studies in patients with epileptic disorders worldwide and animal models of seizure, it has been demonstrated that nAChR activity is altered in some specific types of epilepsy, including autosomal dominant nocturnal frontal lobe epilepsy (ADNFLE) and juvenile myoclonic epilepsy (JME). Neuronal nAChR antagonists also have antiepileptic effects in pre-clinical studies. There is some evidence that conventional antiepileptic drugs may affect neuronal nAChR function. In this review, we re-examine the evidence for the involvement of nAChRs in the pathophysiology of some epileptic disorders, especially ADNFLE and JME, and provide an overview of nAChR antagonists that have been evaluated in animal models of seizure.
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Mutations of the Sonic Hedgehog Pathway Underlie Hypothalamic Hamartoma with Gelastic Epilepsy. Am J Hum Genet 2016; 99:423-9. [PMID: 27453577 DOI: 10.1016/j.ajhg.2016.05.031] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/26/2016] [Indexed: 01/16/2023] Open
Abstract
Hypothalamic hamartoma (HH) with gelastic epilepsy is a well-recognized drug-resistant epilepsy syndrome of early life.(1) Surgical resection allows limited access to the small deep-seated lesions that cause the disease. Here, we report the results of a search for somatic mutations in paired hamartoma- and leukocyte-derived DNA samples from 38 individuals which we conducted by using whole-exome sequencing (WES), chromosomal microarray (CMA), and targeted resequencing (TRS) of candidate genes. Somatic mutations were identified in genes involving regulation of the sonic hedgehog (Shh) pathway in 14/38 individuals (37%). Three individuals had somatic mutations in PRKACA, which encodes a cAMP-dependent protein kinase that acts as a repressor protein in the Shh pathway, and four subjects had somatic mutations in GLI3, an Shh pathway gene associated with HH. In seven other individuals, we identified two recurrent and three single brain-tissue-specific, large copy-number or loss-of-heterozygosity (LOH) variants involving multiple Shh genes, as well as other genes without an obvious biological link to the Shh pathway. The Shh pathway genes in these large somatic lesions include the ligand itself (SHH and IHH), the receptor SMO, and several other Shh downstream pathway members, including CREBBP and GLI2. Taken together, our data implicate perturbation of the Shh pathway in at least 37% of individuals with the HH epilepsy syndrome, consistent with the concept of a developmental pathway brain disease.
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Tesli M, Wirgenes KV, Hughes T, Bettella F, Athanasiu L, Hoseth ES, Nerhus M, Lagerberg TV, Steen NE, Agartz I, Melle I, Dieset I, Djurovic S, Andreassen OA. VRK2 gene expression in schizophrenia, bipolar disorder and healthy controls. Br J Psychiatry 2016; 209:114-20. [PMID: 26941264 DOI: 10.1192/bjp.bp.115.161950] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 09/24/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Common variants in the Vaccinia-related kinase 2 (VRK2) gene have been associated with schizophrenia, but the relevance of its encoded protein VRK2 in the disorder remains unclear. AIMS To identify potential differences in VRK2 gene expression levels between schizophrenia, bipolar disorder, psychosis not otherwise specified (PNOS) and healthy controls. METHOD VRK2 mRNA level was measured in whole blood in 652 individuals (schizophrenia, n = 201; bipolar disorder, n = 167; PNOS, n = 61; healthy controls, n = 223), and compared across diagnostic categories and subcategories. Additionally, we analysed for association between 1566 VRK2 single nucleotide polymorphisms and mRNA levels. RESULTS We found lower VRK2 mRNA levels in schizophrenia compared with healthy controls (P<10(-12)), bipolar disorder (P<10(-12)) and PNOS (P = 0.0011), and lower levels in PNOS than in healthy controls (P = 0.0042) and bipolar disorder (P = 0.00026). Expression quantitative trait loci in close proximity to the transcription start site of the short isoforms of the VRK2 gene were identified. CONCLUSIONS Altered VRK2 gene expression seems specific for schizophrenia and PNOS, which is in accordance with findings from genome-wide association studies. These results suggest that reduced VRK2 mRNA levels are involved in the underlying mechanisms in schizophrenia spectrum disorders.
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Affiliation(s)
- Martin Tesli
- Martin Tesli, MD, PhD, Katrine Verena Wirgenes, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Timothy Hughes, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Francesco Bettella, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Lavinia Athanasiu, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Eva S. Hoseth, MD, Mari Nerhus, MD, Trine V. Lagerberg, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Nils E. Steen, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Drammen District Psychiatric Centre, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway; Ingrid Agartz, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Ingrid Melle, MD, PhD, Ingrid Dieset, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Univ
| | - Katrine Verena Wirgenes
- Martin Tesli, MD, PhD, Katrine Verena Wirgenes, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Timothy Hughes, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Francesco Bettella, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Lavinia Athanasiu, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Eva S. Hoseth, MD, Mari Nerhus, MD, Trine V. Lagerberg, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Nils E. Steen, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Drammen District Psychiatric Centre, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway; Ingrid Agartz, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Ingrid Melle, MD, PhD, Ingrid Dieset, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Univ
| | - Timothy Hughes
- Martin Tesli, MD, PhD, Katrine Verena Wirgenes, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Timothy Hughes, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Francesco Bettella, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Lavinia Athanasiu, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Eva S. Hoseth, MD, Mari Nerhus, MD, Trine V. Lagerberg, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Nils E. Steen, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Drammen District Psychiatric Centre, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway; Ingrid Agartz, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Ingrid Melle, MD, PhD, Ingrid Dieset, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Univ
| | - Francesco Bettella
- Martin Tesli, MD, PhD, Katrine Verena Wirgenes, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Timothy Hughes, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Francesco Bettella, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Lavinia Athanasiu, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Eva S. Hoseth, MD, Mari Nerhus, MD, Trine V. Lagerberg, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Nils E. Steen, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Drammen District Psychiatric Centre, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway; Ingrid Agartz, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Ingrid Melle, MD, PhD, Ingrid Dieset, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Univ
| | - Lavinia Athanasiu
- Martin Tesli, MD, PhD, Katrine Verena Wirgenes, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Timothy Hughes, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Francesco Bettella, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Lavinia Athanasiu, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Eva S. Hoseth, MD, Mari Nerhus, MD, Trine V. Lagerberg, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Nils E. Steen, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Drammen District Psychiatric Centre, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway; Ingrid Agartz, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Ingrid Melle, MD, PhD, Ingrid Dieset, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Univ
| | - Eva S Hoseth
- Martin Tesli, MD, PhD, Katrine Verena Wirgenes, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Timothy Hughes, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Francesco Bettella, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Lavinia Athanasiu, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Eva S. Hoseth, MD, Mari Nerhus, MD, Trine V. Lagerberg, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Nils E. Steen, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Drammen District Psychiatric Centre, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway; Ingrid Agartz, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Ingrid Melle, MD, PhD, Ingrid Dieset, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Univ
| | - Mari Nerhus
- Martin Tesli, MD, PhD, Katrine Verena Wirgenes, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Timothy Hughes, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Francesco Bettella, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Lavinia Athanasiu, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Eva S. Hoseth, MD, Mari Nerhus, MD, Trine V. Lagerberg, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Nils E. Steen, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Drammen District Psychiatric Centre, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway; Ingrid Agartz, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Ingrid Melle, MD, PhD, Ingrid Dieset, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Univ
| | - Trine V Lagerberg
- Martin Tesli, MD, PhD, Katrine Verena Wirgenes, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Timothy Hughes, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Francesco Bettella, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Lavinia Athanasiu, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Eva S. Hoseth, MD, Mari Nerhus, MD, Trine V. Lagerberg, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Nils E. Steen, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Drammen District Psychiatric Centre, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway; Ingrid Agartz, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Ingrid Melle, MD, PhD, Ingrid Dieset, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Univ
| | - Nils E Steen
- Martin Tesli, MD, PhD, Katrine Verena Wirgenes, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Timothy Hughes, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Francesco Bettella, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Lavinia Athanasiu, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Eva S. Hoseth, MD, Mari Nerhus, MD, Trine V. Lagerberg, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Nils E. Steen, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Drammen District Psychiatric Centre, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway; Ingrid Agartz, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Ingrid Melle, MD, PhD, Ingrid Dieset, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Univ
| | - Ingrid Agartz
- Martin Tesli, MD, PhD, Katrine Verena Wirgenes, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Timothy Hughes, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Francesco Bettella, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Lavinia Athanasiu, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Eva S. Hoseth, MD, Mari Nerhus, MD, Trine V. Lagerberg, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Nils E. Steen, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Drammen District Psychiatric Centre, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway; Ingrid Agartz, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Ingrid Melle, MD, PhD, Ingrid Dieset, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Univ
| | - Ingrid Melle
- Martin Tesli, MD, PhD, Katrine Verena Wirgenes, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Timothy Hughes, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Francesco Bettella, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Lavinia Athanasiu, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Eva S. Hoseth, MD, Mari Nerhus, MD, Trine V. Lagerberg, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Nils E. Steen, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Drammen District Psychiatric Centre, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway; Ingrid Agartz, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Ingrid Melle, MD, PhD, Ingrid Dieset, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Univ
| | - Ingrid Dieset
- Martin Tesli, MD, PhD, Katrine Verena Wirgenes, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Timothy Hughes, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Francesco Bettella, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Lavinia Athanasiu, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Eva S. Hoseth, MD, Mari Nerhus, MD, Trine V. Lagerberg, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Nils E. Steen, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Drammen District Psychiatric Centre, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway; Ingrid Agartz, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Ingrid Melle, MD, PhD, Ingrid Dieset, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Univ
| | - Srdjan Djurovic
- Martin Tesli, MD, PhD, Katrine Verena Wirgenes, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Timothy Hughes, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Francesco Bettella, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Lavinia Athanasiu, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Eva S. Hoseth, MD, Mari Nerhus, MD, Trine V. Lagerberg, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Nils E. Steen, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Drammen District Psychiatric Centre, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway; Ingrid Agartz, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Ingrid Melle, MD, PhD, Ingrid Dieset, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Univ
| | - Ole A Andreassen
- Martin Tesli, MD, PhD, Katrine Verena Wirgenes, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Timothy Hughes, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Francesco Bettella, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Lavinia Athanasiu, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Medical Genetics, Oslo University Hospital, Oslo, Norway; Eva S. Hoseth, MD, Mari Nerhus, MD, Trine V. Lagerberg, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Nils E. Steen, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Drammen District Psychiatric Centre, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway; Ingrid Agartz, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, University of Oslo, Oslo, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway; Ingrid Melle, MD, PhD, Ingrid Dieset, MD, PhD, NORMENT, KG Jebsen Centre for Psychosis Research, Institute of Clinical Medicine, Univ
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Loss of function of the retinoid-related nuclear receptor (RORB) gene and epilepsy. Eur J Hum Genet 2016; 24:1761-1770. [PMID: 27352968 DOI: 10.1038/ejhg.2016.80] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 05/01/2016] [Accepted: 05/20/2016] [Indexed: 12/11/2022] Open
Abstract
Genetic generalized epilepsy (GGE), formerly known as idiopathic generalized epilepsy, is the most common form of epilepsy and is thought to have predominant genetic etiology. GGE are clinically characterized by absence, myoclonic, or generalized tonic-clonic seizures with electroencephalographic pattern of bilateral, synchronous, and symmetrical spike-and-wave discharges. Despite their strong heritability, the genetic basis of generalized epilepsies remains largely elusive. Nevertheless, recent advances in genetic technology have led to the identification of numerous genes and genomic defects in various types of epilepsies in the past few years. In the present study, we performed whole-exome sequencing in a family with GGE consistent with the diagnosis of eyelid myoclonia with absences. We found a nonsense variant (c.196C>T/p.(Arg66*)) in RORB, which encodes the beta retinoid-related orphan nuclear receptor (RORβ), in four affected family members. In addition, two de novo variants (c.218T>C/p.(Leu73Pro); c.1249_1251delACG/p.(Thr417del)) were identified in sporadic patients by trio-based exome sequencing. We also found two de novo deletions in patients with behavioral and cognitive impairment and epilepsy: a 52-kb microdeletion involving exons 5-10 of RORB and a larger 9q21-microdeletion. Furthermore, we identified a patient with intellectual disability and a balanced translocation where one breakpoint truncates RORB and refined the phenotype of a recently reported patient with RORB deletion. Our data support the role of RORB gene variants/CNVs in neurodevelopmental disorders including epilepsy, and especially in generalized epilepsies with predominant absence seizures.
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Helbig I, Heinzen EL, Mefford HC. Primer Part 1-The building blocks of epilepsy genetics. Epilepsia 2016; 57:861-8. [PMID: 27226047 DOI: 10.1111/epi.13381] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2016] [Indexed: 12/15/2022]
Abstract
This is the first of a two-part primer on the genetics of the epilepsies within the Genetic Literacy Series of the Genetics Commission of the International League Against Epilepsy. In Part 1, we cover the foundations of epilepsy genetics including genetic epidemiology and the range of genetic variants that can affect the risk for developing epilepsy. We discuss various epidemiologic study designs that have been applied to the genetics of the epilepsies including population studies, which provide compelling evidence for a strong genetic contribution in many epilepsies. We discuss genetic risk factors varying in size, frequency, inheritance pattern, effect size, and phenotypic specificity, and provide examples of how genetic risk factors within the various categories increase the risk for epilepsy. We end by highlighting trends in epilepsy genetics including the increasing use of massive parallel sequencing technologies.
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Affiliation(s)
- Ingo Helbig
- Division of Neurology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.,Department of Neuropediatrics, University Medical Center Schleswig-Holstein, Christian-Albrechts-University, Kiel, Germany
| | - Erin L Heinzen
- Institute for Genomic Medicine and Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York, U.S.A
| | - Heather C Mefford
- Division of Genetic Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, U.S.A
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Diagnostic exome sequencing provides a molecular diagnosis for a significant proportion of patients with epilepsy. Genet Med 2016; 18:898-905. [DOI: 10.1038/gim.2015.186] [Citation(s) in RCA: 243] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 11/03/2015] [Indexed: 11/08/2022] Open
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Loss of synaptic Zn2+ transporter function increases risk of febrile seizures. Sci Rep 2015; 5:17816. [PMID: 26647834 PMCID: PMC4673435 DOI: 10.1038/srep17816] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 11/06/2015] [Indexed: 01/06/2023] Open
Abstract
Febrile seizures (FS) are the most common seizure syndrome and are potentially a prelude to more severe epilepsy. Although zinc (Zn(2+)) metabolism has previously been implicated in FS, whether or not variation in proteins essential for Zn(2+) homeostasis contributes to susceptibility is unknown. Synaptic Zn(2+) is co-released with glutamate and modulates neuronal excitability. SLC30A3 encodes the zinc transporter 3 (ZNT3), which is primarily responsible for moving Zn(2+) into synaptic vesicles. Here we sequenced SLC30A3 and discovered a rare variant (c.892C > T; p.R298C) enriched in FS populations but absent in population-matched controls. Functional analysis revealed a significant loss-of-function of the mutated protein resulting from a trafficking deficit. Furthermore, mice null for ZnT3 were more sensitive than wild-type to hyperthermia-induced seizures that model FS. Together our data suggest that reduced synaptic Zn(2+) increases the risk of FS and more broadly support the idea that impaired synaptic Zn(2+) homeostasis can contribute to neuronal hyperexcitability.
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Sabatello M, Phelan JC, Hesdorffer DC, Shostak S, Goldsmith J, Sorge ST, Winawer MR, Chung WK, Ottman R. Genetic causal attribution of epilepsy and its implications for felt stigma. Epilepsia 2015; 56:1542-50. [PMID: 26290354 DOI: 10.1111/epi.13113] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Research in other disorders suggests that genetic causal attribution of epilepsy might be associated with increased stigma. We investigated this hypothesis in a unique sample of families containing multiple individuals with epilepsy. METHODS One hundred eighty-one people with epilepsy and 178 biologic relatives without epilepsy completed a self-administered survey. In people with epilepsy, felt stigma was assessed through the Epilepsy Stigma Scale (ESS), scored 1-7, with higher scores indicating more stigma and >4 indicating some felt stigma. Felt stigma related to having epilepsy in the family was assessed through the Family Epilepsy Stigma Scale (FESS), created by replacing "epilepsy" with "epilepsy in my family" in each ESS item. Genetic attribution was assessed through participants' perceptions of the (1) role of genetics in causing epilepsy in the family, (2) chance they had an epilepsy-related mutation, and (3) (in people with epilepsy) influence of genetics in causing their epilepsy. RESULTS Among people with epilepsy, 22% met criteria for felt stigma (ESS score >4). Scores were increased among individuals who were aged ≥60 years, were unemployed, reported epilepsy-related discrimination, or had seizures within the last year or >100 seizures in their lifetime. Adjusting for other variables, ESS scores in people with epilepsy were significantly higher among those who perceived genetics played a "medium" or "big" role in causing epilepsy in the family than in others (3.4 vs. 2.7, p = 0.025). Only 4% of relatives without epilepsy had felt stigma. Scores in relatives were unrelated to genetic attribution. SIGNIFICANCE In these unusual families, predictors of felt stigma in individuals with epilepsy are similar to those in other studies, and stigma levels are low in relatives without epilepsy. Felt stigma may be increased in people with epilepsy who believe epilepsy in the family has a genetic cause, emphasizing the need for sensitive communication about genetics.
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Affiliation(s)
- Maya Sabatello
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, U.S.A
| | - Jo C Phelan
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York, U.S.A
| | - Dale C Hesdorffer
- G. H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, U.S.A.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, U.S.A
| | - Sara Shostak
- Department of Sociology, Brandeis University, Waltham, Massachusetts, U.S.A
| | - Jeff Goldsmith
- Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York, U.S.A
| | - Shawn T Sorge
- G. H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, U.S.A
| | - Melodie R Winawer
- G. H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, U.S.A.,Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, U.S.A
| | - Wendy K Chung
- Department of Pediatrics, College of Physicians and Surgeons, Columbia University, New York, New York, U.S.A.,Department of Medicine, College of Physicians and Surgeons, Columbia University, New York, New York, U.S.A
| | - Ruth Ottman
- G. H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, New York, U.S.A.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, U.S.A.,Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, New York, U.S.A.,Division of Epidemiology, New York State Psychiatric Institute, New York, New York, U.S.A
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Lesca G, Depienne C. Epilepsy genetics: the ongoing revolution. Rev Neurol (Paris) 2015; 171:539-57. [PMID: 26003806 DOI: 10.1016/j.neurol.2015.01.569] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 12/24/2014] [Accepted: 01/20/2015] [Indexed: 01/04/2023]
Abstract
Epilepsies have long remained refractory to gene identification due to several obstacles, including a highly variable inter- and intrafamilial expressivity of the phenotypes, a high frequency of phenocopies, and a huge genetic heterogeneity. Recent technological breakthroughs, such as array comparative genomic hybridization and next generation sequencing, have been leading, in the past few years, to the identification of an increasing number of genomic regions and genes in which mutations or copy-number variations cause various epileptic disorders, revealing an enormous diversity of pathophysiological mechanisms. The field that has undergone the most striking revolution is that of epileptic encephalopathies, for which most of causing genes have been discovered since the year 2012. Some examples are the continuous spike-and-waves during slow-wave sleep and Landau-Kleffner syndromes for which the recent discovery of the role of GRIN2A mutations has finally confirmed the genetic bases. These new technologies begin to be used for diagnostic applications, and the main challenge now resides in the interpretation of the huge mass of variants detected by these methods. The identification of causative mutations in epilepsies provides definitive confirmation of the clinical diagnosis, allows accurate genetic counselling, and sometimes permits the development of new appropriate and specific antiepileptic therapies. Future challenges include the identification of the genetic or environmental factors that modify the epileptic phenotypes caused by mutations in a given gene and the understanding of the role of somatic mutations in sporadic epilepsies.
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Affiliation(s)
- G Lesca
- Service de génétique, groupement hospitalier Est, hospices civils de Lyon, 59, boulevard Pinel, 69677 Bron, France; Université Claude-Bernard Lyon 1, 43, boulevard du 11-Novembre-1918, 69100 Villeurbanne, France; CRNL, CNRS UMR 5292, Inserm U1028, bâtiment IMBL, 11, avenue Jean-Capelle, 69621 Villeurbanne cedex, France.
| | - C Depienne
- Département de génétique et cytogénétique, hôpital Pitié-Salpêtrière, AP-HP, 47-83, boulevard de l'Hôpital, 75651 Paris cedex 13, France; Sorbonne universités, UPMC université Paris 06, 4, place Jussieu, 75005 Paris, France; ICM, CNRS UMR 7225, Inserm U1127, 47, boulevard de l'Hôpital, 75651 Paris cedex 13, France
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French JA, Schachter SC, Sirven J, Porter R. The Epilepsy Foundation's 4th Biennial Epilepsy Pipeline Update Conference. Epilepsy Behav 2015; 46:34-50. [PMID: 25922152 DOI: 10.1016/j.yebeh.2015.02.033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 02/09/2015] [Indexed: 10/23/2022]
Abstract
On June 5 and 6, 2014, the Epilepsy Foundation held its 4th Biennial Epilepsy Pipeline Update Conference, an initiative of the Epilepsy Therapy Project, which showcased the most promising epilepsy innovations from health-care companies and academic laboratories dedicated to pioneering and advancing drugs, biologics, technologies, devices, and diagnostics for epilepsy. Speakers and attendees included emerging biotech and medical technology companies, major pharmaceutical and device companies, as well as investigators and innovators at the cutting-edge of epilepsy. The program included panel discussions on collaboration between small and large companies, how to get products in need of funding to the marketplace, who is currently funding epilepsy and CNS innovation, and how the NIH facilitates early-stage drug development. Finally, the conference featured the third annual "Shark Tank" competition. The presentations are summarized in this paper, which is followed by a compilation of the meeting poster abstracts.
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Affiliation(s)
- Jacqueline A French
- Department of Neurology, New York University Langone Medical Center, New York, NY, USA
| | - Steven C Schachter
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Department of Neurology, Harvard Medical School, Boston, MA, USA; Consortia for Improving Medicine Through Innovation and Technology, Boston, MA, USA.
| | - Joseph Sirven
- Department of Neurology, Mayo Clinic Scottsdale, Scottsdale, AZ, USA
| | - Roger Porter
- Department of Neurology, University of Pennsylvania, Philadelphia, PA, USA; Department of Pharmacology, USUHS, Bethesda, MD, USA
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Larsen J, Carvill GL, Gardella E, Kluger G, Schmiedel G, Barisic N, Depienne C, Brilstra E, Mang Y, Nielsen JEK, Kirkpatrick M, Goudie D, Goldman R, Jähn JA, Jepsen B, Gill D, Döcker M, Biskup S, McMahon JM, Koeleman B, Harris M, Braun K, de Kovel CGF, Marini C, Specchio N, Djémié T, Weckhuysen S, Tommerup N, Troncoso M, Troncoso L, Bevot A, Wolff M, Hjalgrim H, Guerrini R, Scheffer IE, Mefford HC, Møller RS. The phenotypic spectrum of SCN8A encephalopathy. Neurology 2015; 84:480-9. [PMID: 25568300 DOI: 10.1212/wnl.0000000000001211] [Citation(s) in RCA: 213] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE SCN8A encodes the sodium channel voltage-gated α8-subunit (Nav1.6). SCN8A mutations have recently been associated with epilepsy and neurodevelopmental disorders. We aimed to delineate the phenotype associated with SCN8A mutations. METHODS We used high-throughput sequence analysis of the SCN8A gene in 683 patients with a range of epileptic encephalopathies. In addition, we ascertained cases with SCN8A mutations from other centers. A detailed clinical history was obtained together with a review of EEG and imaging data. RESULTS Seventeen patients with de novo heterozygous mutations of SCN8A were studied. Seizure onset occurred at a mean age of 5 months (range: 1 day to 18 months); in general, seizures were not triggered by fever. Fifteen of 17 patients had multiple seizure types including focal, tonic, clonic, myoclonic and absence seizures, and epileptic spasms; seizures were refractory to antiepileptic therapy. Development was normal in 12 patients and slowed after seizure onset, often with regression; 5 patients had delayed development from birth. All patients developed intellectual disability, ranging from mild to severe. Motor manifestations were prominent including hypotonia, dystonia, hyperreflexia, and ataxia. EEG findings comprised moderate to severe background slowing with focal or multifocal epileptiform discharges. CONCLUSION SCN8A encephalopathy presents in infancy with multiple seizure types including focal seizures and spasms in some cases. Outcome is often poor and includes hypotonia and movement disorders. The majority of mutations arise de novo, although we observed a single case of somatic mosaicism in an unaffected parent.
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Poduri A. A channel for precision diagnosis and treatment in genetic epilepsy. Ann Neurol 2014; 76:323-4. [PMID: 25092618 DOI: 10.1002/ana.24243] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 08/01/2014] [Accepted: 08/01/2014] [Indexed: 01/25/2023]
Affiliation(s)
- Annapurna Poduri
- Epilepsy Genetics Program, Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, Boston, MA
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Poletaeva I, Surina N, Ashapkin V, Fedotova I, Merzalov I, Perepelkina O, Pavlova G. Maternal methyl-enriched diet in rat reduced the audiogenic seizure proneness in progeny. Pharmacol Biochem Behav 2014; 127:21-6. [DOI: 10.1016/j.pbb.2014.09.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Revised: 09/23/2014] [Accepted: 09/26/2014] [Indexed: 12/18/2022]
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Mignot C, Lambert L, Pasquier L, Bienvenu T, Delahaye-Duriez A, Keren B, Lefranc J, Saunier A, Allou L, Roth V, Valduga M, Moustaïne A, Auvin S, Barrey C, Chantot-Bastaraud S, Lebrun N, Moutard ML, Nougues MC, Vermersch AI, Héron B, Pipiras E, Héron D, Olivier-Faivre L, Guéant JL, Jonveaux P, Philippe C. WWOX-related encephalopathies: delineation of the phenotypical spectrum and emerging genotype-phenotype correlation. J Med Genet 2014; 52:61-70. [PMID: 25411445 DOI: 10.1136/jmedgenet-2014-102748] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Homozygous mutations in WWOX were reported in eight individuals of two families with autosomal recessive spinocerebellar ataxia type 12 and in two siblings with infantile epileptic encephalopathy (IEE), including one who deceased prior to DNA sampling. METHODS By combining array comparative genomic hybridisation, targeted Sanger sequencing and next generation sequencing, we identified five further patients from four families with IEE due to biallelic alterations of WWOX. RESULTS We identified eight deleterious WWOX alleles consisting in four deletions, a four base-pair frameshifting deletion, one missense and two nonsense mutations. Genotype-phenotype correlation emerges from the seven reported families. The phenotype in four patients carrying two predicted null alleles was characterised by (1) little if any psychomotor acquisitions, poor spontaneous motility and absent eye contact from birth, (2) pharmacoresistant epilepsy starting in the 1st weeks of life, (3) possible retinal degeneration, acquired microcephaly and premature death. This contrasted with the less severe autosomal recessive spinocerebellar ataxia type 12 phenotype due to hypomorphic alleles. In line with this correlation, the phenotype in two siblings carrying a null allele and a missense mutation was intermediate. CONCLUSIONS Our results obtained by a combination of different molecular techniques undoubtedly incriminate WWOX as a gene for recessive IEE and illustrate the usefulness of high throughput data mining for the identification of genes for rare autosomal recessive disorders. The structure of the WWOX locus encompassing the FRA16D fragile site might explain why constitutive deletions are recurrently reported in genetic databases, suggesting that WWOX-related encephalopathies, although likely rare, may not be exceptional.
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Affiliation(s)
- Cyril Mignot
- Département de Génétique, Groupe Hospitalier Pitié-Salpêtrière, APHP; Centre de Référence des Déficiences Intellectuelles de Causes Rares, UPMC Univ Paris 06 Groupe de Recherche Clinique "Déficience Intellectuelle et Autisme", Paris, France
| | - Laetitia Lambert
- Unité Fonctionnelle de Génétique Clinique, Service de Médecine Néonatale, Maternité Régionale Universitaire, Nancy, France
| | - Laurent Pasquier
- Service de Génétique Clinique, Hôpital Sud, CLAD Ouest, Rennes, France
| | - Thierry Bienvenu
- Laboratoire de Biochimie et Génétique Moléculaire, GH Cochin-Broca-Hôtel Dieu, APHP, Inserm U1016, Institut Cochin, Université Paris Descartes, CNRS (UMR 8104), Paris, France
| | | | - Boris Keren
- Département de Génétique, Groupe Hospitalier Pitié-Salpêtrière, APHP; Centre de Référence des Déficiences Intellectuelles de Causes Rares, UPMC Univ Paris 06 Groupe de Recherche Clinique "Déficience Intellectuelle et Autisme", Paris, France
| | - Jérémie Lefranc
- Service de Pédiatrie, Centre Hospitalo-Universitaire Morvan, Brest, France
| | - Aline Saunier
- Laboratoire de Génétique Médicale, Centre Hospitalier Régional et Universitaire, Vandoeuvre-les-Nancy, France
| | - Lila Allou
- Université de Lorraine, Inserm U954 Nutrition-Genetics-Environmental Risk Exposure, Medical Faculty, Vandoeuvre-les-Nancy, France
| | - Virginie Roth
- Laboratoire de Génétique Médicale, Centre Hospitalier Régional et Universitaire, Vandoeuvre-les-Nancy, France
| | - Mylène Valduga
- Laboratoire de Génétique Médicale, Centre Hospitalier Régional et Universitaire, Vandoeuvre-les-Nancy, France
| | - Aissa Moustaïne
- Laboratoire de Génétique Médicale, Centre Hospitalier Régional et Universitaire, Vandoeuvre-les-Nancy, France
| | - Stéphane Auvin
- APHP, Hôpital Robert Debré, Service de Neurologie Pédiatrique; Univ Paris Diderot, Sorbonne Paris Cité, INSERM UMR1141, Paris, France
| | - Catherine Barrey
- Service de Pédiatrie, Hôpital Saint-Camille, Bry-sur-Marne, France
| | | | - Nicolas Lebrun
- Laboratoire de Biochimie et Génétique Moléculaire, GH Cochin-Broca-Hôtel Dieu, APHP, Inserm U1016, Institut Cochin, Université Paris Descartes, CNRS (UMR 8104), Paris, France
| | | | | | | | - Bénédicte Héron
- Service de Neuropédiatrie, APHP, Hôpital Armand Trousseau, Paris, France Service de Pédiatrie, APHP, Hôpital Jean Verdier, Bondy, France
| | - Eva Pipiras
- Unité de Cytogénétique, Hôpital Jean Verdier, APHP, CHU-Paris 13, Bondy, France
| | - Delphine Héron
- Département de Génétique, Groupe Hospitalier Pitié-Salpêtrière, APHP; Centre de Référence des Déficiences Intellectuelles de Causes Rares, UPMC Univ Paris 06 Groupe de Recherche Clinique "Déficience Intellectuelle et Autisme", Paris, France
| | - Laurence Olivier-Faivre
- Medical Genetics Unit, Centre Hospitalier Universitaire de Dijon; Research Unit EA 4271 Génétique des Anomalies du Développement, Université de Bourgogne, PRES Bourgogne-Franche Comté, Dijon, France
| | - Jean-Louis Guéant
- Université de Lorraine, Inserm U954 Nutrition-Genetics-Environmental Risk Exposure, Medical Faculty, Vandoeuvre-les-Nancy, France
| | - Philippe Jonveaux
- Laboratoire de Génétique Médicale, Centre Hospitalier Régional et Universitaire, Vandoeuvre-les-Nancy, France. Université de Lorraine, Inserm U954 Nutrition-Genetics-Environmental Risk Exposure, Medical Faculty, Vandoeuvre-les-Nancy, France
| | - Christophe Philippe
- Laboratoire de Génétique Médicale, Centre Hospitalier Régional et Universitaire, Vandoeuvre-les-Nancy, France. Université de Lorraine, Inserm U954 Nutrition-Genetics-Environmental Risk Exposure, Medical Faculty, Vandoeuvre-les-Nancy, France
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Ran X, Li J, Shao Q, Chen H, Lin Z, Sun ZS, Wu J. EpilepsyGene: a genetic resource for genes and mutations related to epilepsy. Nucleic Acids Res 2014; 43:D893-9. [PMID: 25324312 PMCID: PMC4384015 DOI: 10.1093/nar/gku943] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Epilepsy is one of the most prevalent chronic neurological disorders, afflicting about 3.5–6.5 per 1000 children and 10.8 per 1000 elderly people. With intensive effort made during the last two decades, numerous genes and mutations have been published to be associated with the disease. An organized resource integrating and annotating the ever-increasing genetic data will be imperative to acquire a global view of the cutting-edge in epilepsy research. Herein, we developed EpilepsyGene (http://61.152.91.49/EpilepsyGene). It contains cumulative to date 499 genes and 3931 variants associated with 331 clinical phenotypes collected from 818 publications. Furthermore, in-depth data mining was performed to gain insights into the understanding of the data, including functional annotation, gene prioritization, functional analysis of prioritized genes and overlap analysis focusing on the comorbidity. An intuitive web interface to search and browse the diversified genetic data was also developed to facilitate access to the data of interest. In general, EpilepsyGene is designed to be a central genetic database to provide the research community substantial convenience to uncover the genetic basis of epilepsy.
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Affiliation(s)
- Xia Ran
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou 325000, China
| | - Jinchen Li
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou 325000, China
| | - Qianzhi Shao
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou 325000, China
| | - Huiqian Chen
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou 325000, China
| | - Zhongdong Lin
- Department of Pediatric Neurology, The Second Affiliated & Yuying Children's Hospital, Wenzhou Medical University, Wenzhou 325000, China
| | - Zhong Sheng Sun
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou 325000, China Beijing Institutes of Life Science, Chinese Academy of Science, Beijing 100101, China
| | - Jinyu Wu
- Institute of Genomic Medicine, Wenzhou Medical University, Wenzhou 325000, China Beijing Institutes of Life Science, Chinese Academy of Science, Beijing 100101, China
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Okeke JO, Tangel VE, Sorge ST, Hesdorffer DC, Winawer MR, Goldsmith J, Phelan JC, Chung WK, Shostak S, Ottman R. Genetic testing preferences in families containing multiple individuals with epilepsy. Epilepsia 2014; 55:1705-13. [PMID: 25266816 DOI: 10.1111/epi.12810] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2014] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To examine genetic testing preferences in families containing multiple individuals with epilepsy. METHODS One hundred forty-three individuals with epilepsy and 165 biologic relatives without epilepsy from families containing multiple affected individuals were surveyed using a self-administered questionnaire. Four genetic testing scenarios were presented, defined by penetrance (100% vs. 50%) and presence or absence of clinical utility. Potential predictors of genetic testing preferences were evaluated using generalized estimating equations with robust Poisson regression models. The influence of 21 potential testing motivations was also assessed. RESULTS For the scenario with 100% penetrance and clinical utility, 85% of individuals with epilepsy and 74% of unaffected relatives responded that they would definitely or probably want genetic testing. For the scenario with 100% penetrance but without clinical utility, the proportions who responded that they would want testing were significantly lower in both affected individuals (69%) and unaffected relatives (57%). Penetrance (100% vs. 50%) was not a significant predictor of genetic testing interest. The highest-ranking motivations for genetic testing were the following: the possibility that the results could improve health or health care, the potential to know if epilepsy in the family is caused by a gene, and the possibility of changing behavior or lifestyle to prevent seizures. SIGNIFICANCE Interest in epilepsy genetic testing may be high in affected and unaffected individuals in families containing multiple individuals with epilepsy, especially when testing has implications for improving clinical care.
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Affiliation(s)
- Janice O Okeke
- GH Sergievsky Center, Columbia University, New York, New York, U.S.A; Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, U.S.A
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